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Move over, banana bread — it’s time for this peachy bourbon loaf

For the last several months, banana bread has become the MVP of many people’s pandemic stress-baking roster — and understandably so. It’s a cheap, easy way to get something sweet on the table without waiting for dough to proof or creating layers to frost, while also using up the inevitable overripe bananas of the bunch. 

But it’s peach season here in the South (marked in part by the annual Peach Truck tour which – though it looks different this year due to social distancing – travels up the coast delivering Georgia peaches) so I thought it’d be nice to create a loaf that showcased peaches as the star. 

The key to this recipe is really found in the first step, which is a play on a fruit compote. By softening the peaches in bourbon, it brings out their natural sugar and “fruitiness,” while also infusing the bread with a touch of caramel flavor. 

Bourbon Peach Bread 

1½ cups all-purpose flour
1¼ teaspoons baking soda
¾ teaspoon salt
1 cup brown sugar, plus 2 additional tablespoons 
⅓ cup sour cream
¼ cup vegetable oil
1 teaspoon vanilla extract
2 tablespoons of bourbon
2 large eggs
1 cup grated or finely chopped peaches

In a small saucepan, combine bourbon, 2 tablespoons of brown sugar, and 1 cup of peaches, over medium high heat. Stir until the peaches have softened and the sugar has dissolved into the bourbon. Set aside. 

In a large mixing bowl, combine vegetable oil, sour cream, vanilla extract and two eggs. Fold in the remaining dry ingredients and stir until completely combined, followed by the peach mixture. 

Grease a standard loaf pan (I like to line it with parchment paper, too, just for an easier removal from the pan) and add the batter. Place in an oven that has been heated to 350 degrees. Bake bread until a tester inserted into the center comes out clean, 60–65 minutes. Transfer the pan to a wire rack and let bread cool in the pan for one hour, before popping it out on the rack. 

 

Life after layoffs: How empanadas gave me a sense of belonging

When COVID-19 reached the United States, I was working full time as an in-house content writer for a company that was about to launch a credit card review website. I kept coming into work each day feeling secure that this pandemic surely wouldn’t affect the industry I worked in. It wasn’t long before human resources decided that I, along with other creative team members, were costing the company too much in the midst of this health crisis and dismissed us.

I drove home, thinking about what I was going to do. It felt as though something greater than myself took over, and I made a detour to my favorite Latino grocery store. I felt myself guided towards the ingredients I needed to make Peruvian-style empanadas: a cartload of red onions, a big hunk of beef eye round (what is referred to as “boliche”), butter, lard, ají amarillo chilies, cumin, and oregano. I loaded my trunk with the groceries, pulled out my phone, and announced to my social media followers that I had just gotten laid off and would be selling Peruvian empanadas that week.

There was only one problem: I realized that I didn’t quite know how to make Peruvian empanadas yet.

All I had were my taste memories — the perfect buttery, crumbly crust and moist beef fillings I had tried in Lima — and various, lackluster attempts at home. In the past, I had thrown out more botched turnovers than I’d like to admit — crusts that exploded in the oven, fillings that were too soupy and leaked all over the baking tray. Empanadas weren’t something I wasn’t quite comfortable serving to guests, much less selling for profit. What was I thinking?

I assumed I would get a handful of orders from supportive friends, and that I’d maybe sell a dozen of these tender meat pies by the end of the week. But the next morning I woke up to find more orders than I had ingredients for.

It then dawned on me that whoever or whatever took over me when I decided to start selling empanadas was a genius. (Or maybe I was the genius and needed to give myself more credit.)

All my life, I’ve had dreams of owning a small food business, but I never knew what to sell. I didn’t know what food — signature dish, let alone cuisine — I could call mine. Miami is a major hub for Peruvian immigrants, and while my birth country’s cuisine is extremely popular with locals, there is also a lot of competition. I couldn’t simply cook Peru’s greatest culinary hits and expect to make a mark. There were already dozens of my compatriots doing the same thing, and they had a lot more experience and resources to work with.

But, I realized there weren’t that many purveyors of Peruvian-style empanadas around me. These are unique in Latin America in that the crust is crumbly, buttery, and melts in your mouth much like shortbread. In fact, there were only two Peruvian bakeries in the tri-county area that I knew of, and I wasn’t a big fan of either bakery’s empanadas — the fillings were dry, and one bakery’s crust reminded me of a soggy fast food biscuit. I wanted to make the empanadas that I wanted to eat — ones with delicate crusts made with good quality butter and lard (instead of margarine and shortening) and juicy, savory fillings.

Miami’s population is roughly 65 percent Latino, obsessed with any type of savory hand pie, and — like much of the world — has been quarantined for months. I was offering an injection of excitement into their diet and free delivery to almost anywhere in my corner of Florida. I started finding myself busier than when I was employed; in early June, I even purchased a second refrigerator to keep up with the orders.

Perhaps the biggest revelation has been the amount of satisfaction I could derive from work. Few things compare to having a complete stranger purchase something you create week after week, and tell you how your food brings them pleasure during such a dreary time.

As someone who is bi-cultural, I’ve never felt wholly accepted. The Anglo-American community to which my mother belongs could never accept anyone named Carlos; the Peruvian-American community welcomes me tepidly, but my accent and the fact I grew up in the U.S. keep me from being seen as Peruvian. After 30 years of living in America, I finally found that sense of belonging: a Peruvian customer’s mamá — herself a caterer — called to commend me on my empanadas.

I have tried adding some fusion dishes to my menu as a nod to my multicultural upbringing — I was particularly proud of a Peruvian riff on pimento cheese sandwiches — but my customers wouldn’t even consider it. They wanted the foods that reminded them of home, and that’s what made me truly Peruvian in their eyes.

I named my budding business 3 Coronas (“corona” means crown in Spanish). The name is a tribute to not only the city where I was born — Lima, the Thrice Crowned City of Kings — but these very strange times, in which I, very strangely, found myself.

Empanadazo (Peruvian-style Giant Empanada)

Prep time: 20 minutes

Cook time: 45 minutes

Serves: 4 to 6

Ingredients:

  • 1 tablespoon olive oil
  • 1 bay leaf
  • 1/2 pound ground beef (80% lean)
  • 1/2 pound onions, diced (any type of onion will do)
  • 2 garlic cloves, minced
  • 1/4 teaspoon ground cumin
  • 1/2 teaspoon dried oregano
  • 1 beef bouillon cube (optional)
  • kosher salt and freshly ground pepper
  • 1 frozen pie crust
  • 1 egg, beaten
  • Powdered sugar, for dusting
  • Lime wedges, for serving

Directions

  1. Place a rack in the middle of the oven, and preheat to 400°F. Line a baking sheet with parchment paper and set aside.
  2. Set a large sauté pan or skillet over medium-high heat. Add olive oil and bay leaf. Fry the bay leaf until it browns slightly.
  3. Add the ground beef and brown, breaking apart any large clumps with a spoon or spatula. When browned, add the onions and a generous pinch of salt, and stir to combine. Fry until the onions begin to soften.
  4. Add the garlic, cumin, oregano, and bouillon cube, if using. Stir to combine well, and continue cooking until the onions soften completely and look melted. By this point most of the liquid should have evaporated. If not, continue frying until the mixture is moist but not soupy. Season to taste with salt and pepper, and transfer beef filling to a bowl to cool. (Filling will keep in the refrigerator for up to 1 day.)
  5. When ready to assemble, unroll the pie crust and place it over the parchment-lined baking sheet. When the filling has cooled to room temperature, mound it on one side of the pie crust, leaving about 1 inch of crust around the edges.
  6. Now carefully bring the other side of the pie crust over the beef filling so that it covers it completely. The edges of the crust should meet. If not, you can gently press the filling through the dough to disperse it more evenly, or unfold the dough and rearrange the filling with a spoon.
  7. Now crimp the edges securely with the tines of a fork or pinch with your fingers. Make sure there are no gaps or cracks in the crust. Brush with the beaten egg and bake until the crust is cooked through and golden brown, about 30 minutes.
  8. Let cool slightly, about 10-15 minutes. Dust the giant empanada with powdered sugar, slice, and serve with lime wedges.

 

Eyes up here: In “P-Valley,” the strippers and their grueling labor are the headliners, not men

“P-Valley” spends its first episode building towards a climactic performance by Mercedes (Brandee Evans), top diva at a Dirty South strip club called Pynk. When Mercedes takes the stage, she attacks the pole with steeled muscle and such tenacity that you barely notice the crowd hooting or the dollars raining down.

Then you don’t hear any of it because the sound fades away, leaving nothing but Mercedes, her athleticism and strength spotlighted as the only barriers between height and breakneck tragedy.

Mercedes grunts as she climbs to the ceiling, shifts herself upside down and slams her heels against the inner sky, shaking her hair with extreme force. Her drop back to Earth is a shock to the system, enough to mute the trap beat that come pulsing back in.

“P-Valley” creator Katori Hall writes such moments to announce with incisive clarity that this series is not about fantasy girls, but real women. In all our conversations about gaze, this is a show that puts its dollars where the female perspective is, with every episode directed by a woman and every note dedicated to depicting the work, muscle and risk that goes into their shows of seemingly effortless pleasure.

Withing various cultural awakenings occurring right now, the drumbeat refrain of “sex work is work” tends to be the least appreciated. “P-Valley” blasts that truth over its loudspeakers inviting us to see the world from the vantage point of hard workers whose efforts are regularly denigrated. This is doubly true for the women at Pynk, residents in the fictional Mississippi Delta town of Chucalissa.

Pretty is not how you’d describe the surrounding environs. Although the exterior looks rusty and its immediate surrounding a weedy mess, the Pynk’s gender-fluid proprietor Uncle Clifford (Nicco Annan) keeps it exquisite on the inside, especially in the backrooms – V.I.P., Champagne and levels above. Clifford’s rotating fashion collection and diving wig game are as much of a sight to behold as the dancers in her establishment; if you aren’t partial to the scantily clad women, consider that eye candy to be additional insurance for your time investment.

Of higher value than the state of Clifford’s beaten face and flawless manicure, though, is the well-being of the women who work with her, even if some are more difficult to know than others. One such soul goes by Autumn Night (Elarica Johnson), the lighter-skinned newcomer whose arrival immediately draws Mercedes’ ire.

The veteran dancer isn’t envious of Autumn’s looks or her fresh meat status, and although Autumn’s complexion is a real source of tension, the larger potential problem as Mercedes sees it is that her new co-worker will easily eat into her tips simply by being there. In other words, simply by being closer to white in a world populated by dark-skinned women, she’ll get paid more for doing half the work.

It’s an economic concern, in other words – especially since Mercedes is on the verge of opening up her own dance studio for her team of school girls. This isn’t some version of the stereotypical stripper’s dream but a reality. She has the site locked down. All that remains is for her and Clifford, and the rest of the town, to survive the plans of real-estate developers who have millions to play against their thousands, and hundreds, and less.

“P-Valley” expands upon the story Hall initially told in her 2015 play “Pussy Valley” in which she set out to place characters typically shown as voiceless background accessories to the fore, weaving their stories in all their fullness and flaws. Setting the story in an economically blighted Southern town ensures the eight-episode series enables Hall, who serves as showrunner, to maintain focus on topics and social flashpoints other writers may downplay or leave out entirely. These also make “P-Valley” sharply relevant at a time when the nation is examining structural racism in every industry – including strip clubs.

Under Hall’s guidance “P-Valley” bakes in issues about colorism, gender discrimination and class conflict from its very first moment, and it doesn’t skimp on the lyricism or the humor, sliding plenty of each into its dialogue and often having them meet in the form of Lil’ Murda (J. Alphonse Nicholson), a marginally talented hip-hop artist and club regular. Tellingly the rapper is a secondary performer here, not the star, and we’re left to wonder less about him than Johnson’s mystery woman, seen in the aftermath of a hurricane – which one is never specified – as the series opens.

Face bruised and pulling a suitcase out of a disaster’s mud puddle, “Autumn” opens it to find a dirty wallet with an identification card that isn’t hers, a designer purse and a pair of sky high heels, the red soles marking them as Louboutins.

They’re all she has and what she wears to the “Booty Battle” that gains her entry into this world: a thin armor of propriety in a space written off as indecent. And she finds that otherwise valuable social currency is worth less than what’s underneath it.

Despite how that reads, “P-Valley” is not another morality story that paints these characters as tragic figures. Quite the opposite – Hall takes all the ingredients that go into the respectability politics Black culture and society at large hangs on the necks of these women and the men surrounding them, and shreds them in a blender. One subplot involves Mercedes’ holy roller, churchgoing mother who is full of insults for her daughter while easily accepting a portion of the money she earns.

And this is part of Hall’s conscientious examination of bodies as tools of labor – the value of Black bodies specifically in a world that devalues them and assigns lesser worth to women, especially these women.

“P-Valley” doesn’t shy away from the hypocrisy of holier-than-thou figures of the community judging and insulting these women and Uncle Clifford while reaping the benefits of their hard work. Such threads afford the likes of Isaiah Washington, almost unrecognizable in his outstanding performance as the town’s crooked mayor, to churn out mesmerizing appearances.

At no point are we asked to feel sorry for the denizens of Pynk, though. There are no victims here, but survivors; no fallen women, just mothers, entrepreneurs with their eyes on the future, or in the case of the place’s sole white performer Gidget (Skyler Joy), continuing the family’s tradition. Even Keyshawn (Shannon Thornton), a dancer who returns from maternity leave with purple marks on her neck and a split lip, is doing what she needs to do for her child.

In all respects, “P-Valley” sides with these women and those who support them while previewing threats on the horizon. Their view informs the focus in the writing, the directing and the performances, turning every stereotype about these places and these women on its head and presenting them from a view that serves their perspective, for once. And when the story inevitably succumbs to some of its more melodramatic inclinations, no part of its potency declines in the bargain. Consider that to be a bonus, of the good time to be had in watching these women thanklessly work, possibly shifting your point of view in the bargain.

“P-Valley” premieres Sunday, July 12 at 8 p.m. on Starz.

Child care industry, rocked by coronavirus, set to face new round of uncertainty

Workers in the U.S. are staring down the precipice as lawmakers fail to address the economic ravages of the pandemic. Even as some 21 million people remain unemployed, the $600 per week in additional unemployment insurance created by Congress’s coronavirus relief package, the CARES Act, is set to expire on July 31. Student debt payments will resume on October 1 for the 34 million federal student loan borrowers whose loans were suspended by CARES. But perhaps no cliff is as steep as the early care and education sector, which may be cut in halfby the time the pandemic is over. To save it, the sector will need an infusion of at least $50 billion. But so far, despite how essential child care is to restarting the economy, Congress has been unwilling to meet the crisis with the resources required to stave off a crisis.

The extent of the child care crisis may seem invisible to many while there are people who haven’t returned to in-person work yet. When they do, they may find their daycares gone or full. Child care centers are already closing en masse: an April survey by the National Association for the Education of Young Children showed that half of survey respondents have already had to close their child care center. Of the centers still open, 85 percent are operating at less than half of their enrollment capacity, leading to substantial financial losses for early educators.

Before the pandemic, it was already difficult to find space in an early care and education center, with long childcare waiting lists in many states and cities. But in addition to being under-available, child care workers themselves are underpaid relative to the extraordinary role they play. The most important part of brain development happens during early childhood. In the first few years of life, more than 1 million new neural connections are formed every second. This period is crucial for emotional-social development and cognitive-linguistic abilities that form the basis for later success in a child’s life. Expanding child care is also job-enabling as it frees up women in particular to work, and the dollars invested in it create a positive return for society overall, as economist Eileen Appelbaum has noted. A study of one preschool education program showed every dollar invested yielded $7 to $12 back to society. Yet, despite the crucial role child care providers play in childhood development and society overall, child care workers make an average of just $11.42 an hour, or $23,760 annually. This low pay generally is not matched with benefits, either. About half of workers in non-child care occupations receive health insurance from their job, but only 15 percent of child care workers do, according to an analysis by the Economic Policy Institute (EPI). EPI also found that one in seven child care workers live in families with income below the official poverty line. Despite low wages and few benefits, 23 states with public pre-K programs require lead teachers to have at least a bachelor’s degree. Research has shown that this kind of “credentialization” particularly harms workers of color, who are forced to take on more student debt to acquire the credentials employers demand as a barrier to entry.

The perception of child care as merely “babysitting” when it’s a crucial part of early childhood development and education is part of a general devaluation of care work. Child care is an example of what theorists call social reproduction work: the social processes that produce the conditions that allow work to happen in the first place. Tithi Bhattacharya, Purdue University professor and editor of Social Reproduction Theory: Remapping Class, Recentering Oppression, told journalist Sarah Jaffe that social reproduction is “life-making” activities: cleaning, cooking, child care and health care. Social reproduction work generally is dominated by women, often women of color; child care especially so. Ninety-three percent of jobs in child care are held by women, according to Labor Department data, and 45.3 percent are Black, Asian or Latinx. As with many essential workers, the pandemic laid bare how the long-underpaid child care workers form a backbone of our economy.

Congressional action has been terrifyingly insufficient. The CARES Act dedicated a mere $3.5 billion to the Child Care and Development Block Grant. This level of funding does not even cover a month’s worth of costs for existing providers: a joint report by the National Women’s Law Center and the Center for Law and Social Policy (CLASP) showed it would take $9.6 billion a month to maintain the sector during the pandemic. Even the Democrats’ Heroes Act, which passed the House in May but has stalled in the Senate, provides only $7 billion of the estimated $50 billion minimum needed to truly save the child care sector.

Congress’s failure to take meaningful, early action has already cost us. More than a third of all child care workers have lost their jobs since March — nearly 330,000 people, or one third of the entire sector. Ongoing inaction threatens to disrupt the livelihood of the remaining child care workers still employed, as well as the 11.8 million families who depend on weekly care with non-parental providers.

In response, Democratic lawmakers, led by Reps. Rosa DeLauro and Bobby Scott as well as Sen. Patty Murray, have introduced the Child Care Is Essential Act, which would create a $50 billion Child Care Stabilization Fund that provides grants to providers who keep staff on payroll and adhere to health guidelines. This amount is the absolute minimum investment to save the sector, according to CLASP, and it will not be sufficient should the pandemic last more than five months. There is some inkling of bipartisan support, with two Republican senators, Joni Ernst and Kelly Loeffler, calling for additional funds in the next relief package, though they are asking for just $25 billion. In the meantime, as the Senate continues to stall on coronavirus legislation, Sen. Elizabeth Warren led a letter to the Treasury and Small Business Administration urging them to ensure child care centers are able to access the Paycheck Protection Program, as only a quarter have received loans to date.

Long undervalued child care providers are especially hard hit by the coronavirus pandemic. Congress’s meager provision for early childhood education providers is insufficient at best. Child care providers are vital to our economy and deserve a bailout that recognizes their significance. Failing to bail out the child care sector will stunt economic recovery, stunt the development of children denied access to enriching child care programs, and adversely affect the child care providers who made a career of educating our nation’s young children.

Copyright © Truthout. Reprinted with permission.

How 68,000 COVID-19 survivors created a world-class patient resource group in just four months

Diana Berrent was one of the first people in her hometown of Port Washington, New York, to get COVID-19. Back then, in early March 2020, only immunocompromised and seniors were believed to be high-risk; hence, as a 46-year-old yoga practitioner and runner, Berrent was “shocked” when she woke up with a 103-degree fever and respiratory infection — symptoms that strongly suggested she had coronavirus, which was later confirmed by a test.

“You don’t even think that you’re going to be the first person on your block to catch the plague, but you know, life comes at you fast,” Berrent mused.

While self-isolating in her home, Berrent spent much of her time researching coronavirus online. She was particularly confused as to why she had terrible gastrointestinal issues; at the time, those were not considered to be a main symptom.

“There was this clear dearth of information,” Berrent said. “I had one phone call with my doctor, but by the time I spoke with him I knew far more about the virus than he did, and that was only a week into it,” she added.

That week, Berrent started the Facebook group Survivor Corps, a support group for those recovering from COVID-19. 

Survivor Corps was created on March 24; as of July 10, it has over 68,000 members. Berrent said she started the group as a way to mobilize volunteers to donate convalescent plasma to those who would be later fighting COVID-19, or support scientific medical and academic research that they qualified for in order to help find a cure.

“It was a way of gathering all these people who are currently sick, but who were going to be survivors pretty soon,” Berrent said. Once cases started to surge in New York, the Facebook group took off almost overnight.

“As soon as April hit and New York got slammed our membership skyrocketed,” she said. “We now have a volunteer staff, a couple of dozen volunteers who work tirelessly to make sure that if you make a statement of health or medical facts and it’s not accompanied by a verified source, it gets taken down.”

Indeed, the group has become a wealth of data and knowledge for people who have COVID-19 or suspect that they do. 

“You can’t give anyone else medical advice, but you can give your own anecdotal information, and as a result, we have created what amounts to probably the greatest data set on survivors in the world,” Berrent said.

Not only has the group become a place to exchange anecdotes about symptoms, but it’s also become a community where people feel heard in what can be a very isolating experience.

Jennifer English, a 46-year-old living in Oregon City, Oregon, sat down to have dinner with her son on April 4 when she realized that she couldn’t taste her food.

“I instantly sat down in my chair and my heart just sank because I just knew from that point that I had it,” English said.

At first, it was hard for her to get a test. English said she was dismissed by doctors who told her she had anxiety. It wasn’t until she went to the emergency room on April 14 and was able to get a test. Two days later, she found out she was positive.

During those two days, English said she felt alone, as her friends either did not believe she had COVID-19 or, in some cases, believed it was a hoax or as benign as the flu.  After documenting her experience on Facebook, a friend told her about Survivor Corps.  

“Within 10 minutes I no longer felt alone — all these people they got me, they understood what I was going through,” English said, adding that the group had “everything to do” with her recovery.

“The ER told me that I shouldn’t go back unless my temperature was over 103 or my lungs started failing — at that point I felt like I had nowhere to turn but Survivor Corps,” English said, adding that she would wake up every morning and get on Survivor Corps. “So that I had somebody to talk to and, and somebody that got me because I honestly, for about 14 days, thought I was dying every day.”

English ended up making “virus buddies” across the world.

“One in Italy and one in Dubai and one in New York,” English said. “We would check in on each other every day.”

English still checks in regularly with one virus buddy who is a “long hauler,” meaning someone who experiences symptoms weeks or months after having the coronavirus. Two of her virus buddies have “pretty much resumed their lives again.”

Jan Weinstein, a 58-year-old living in Forest Hills, New York, got tested for COVID-19 on March 16 when she first started to experience symptoms, but her test came back negative. Yet she continued to experience strange things happening to her body, which is why she got an antibody test.

“And sure enough, I had the antibodies,” Weinstein said. Not too long after, a friend pointed her to Survivor Corps.

“It totally opened my eyes to what I had written off as being just strange things to this is definitely tied to COVID,” Weinstein said. “It also helped me learn that I in fact could make a difference by donating plasma and I’ve been very focused on that actually. I have a second appointment on Monday.”

Nathalie Theodore, JD, LCSW, a psychotherapist in Chicago, told Salon online communities can be “a great source of comfort and support” for those who have been diagnosed with COVID-19.

“In this day and age, where in-person social interactions are limited, it helps to virtually connect with others who may have had a similar experience,” Theodore said. “There are still so many questions about this virus, and, for some, that uncertainty can lead to anxiety.”

Certainly, this sense of community has factored into the success of the group.

“In most situations you would say … don’t go to the internet for medical information,” Berrent said. “But these are not normal times.”

Berrent, who is still experiencing symptoms four months later, said it is comforting knowing she’s not alone. 

“To have that validation is extraordinarily important,” Berrent said.

Tulsa undercover: Inside Trump’s rally

It was June 20th and we antiwar vets had traveled all the way to Tulsa, Oklahoma, in the midst of a pandemic to protest President Trump’s latest folly, an election 2020 rally where he was to parade his goods and pretend all was well with this country.

We never planned to go inside the cavernous arena where that rally was to be held. I was part of our impromptu reconnaissance team that called an audible at the last moment. We suddenly decided to infiltrate not just the perimeter of that Tulsa rally, but the BOK Center itself. That meant I got a long, close look at the MAGA crowd there in what turned out to be a more than half-empty arena.

Our boots-on-the-ground coalition of two national antiwar veteran organizations — About Face and Veterans for Peace (VFP) — had thrown together a rather risky direct action event in coordination with the local activists who invited us.

We planned to climb the three main flagpoles around that center and replace an Old Glory, an Oklahoma state flag, and a Tulsa one with Black Lives-themed banners. Only on arrival, we found ourselves stymied by an eleventh-hour change in the security picture: new gates and unexpected police deployments. Hopping metal barriers and penetrating a sizable line of cops and National Guardsmen seemed to ensure a fruitless trip to jail, so into the under-attended indoor rally we went, to — successfully it turned out — find a backdoor route to those flagpoles.

Once inside, we had time to kill. While others in the group infiltrated and the flagpole climbers donned their gear, five of us — three white male ex-foot soldiers in America’s forever wars and two Native American women (one a vet herself) — took a breather in the largely empty upper deck of the rally. Nervous joking then ensued about the absurdity of wearing the Trump “camouflage” that had eased our entrance. My favorite disguise: a Hispanic ex-Marine buddy’s red-white-and-blue “BBQ, Beer, Freedom” tank top.

The music irked me instantly. Much to the concern of the rest of the team, I’d brought a notebook along and was already furtively scribbling. At one point, we listened sequentially to Michael Jackson’s “Billie Jean,” The Beatles’s “Let It Be,” and Queen’s “We Are The Champions” over the arena’s loudspeakers. I couldn’t help but wonder how that black man of, let’s say, complicated sexual orientation, four outspoken British hippies, and a gay AIDs victim (Freddie Mercury) would feel about the way the Trump campaign had co-oped their songs. We can guess though, since the late Tom Petty’s family quickly denounced the use of his rock song “I Won’t Back Down” at the rally.

I watched an older white woman in a “Joe Biden Sucks, Nancy Pelosi Swallows” T-shirt gleefully dancing to Michael Jackson’s falsetto (“But the kid is not my son!”). Given that “Billie Jean” blatantly describes an out-of-wedlock paternity battle and that odds were this woman was a pro-life proponent of “family values,” there was something obscene about her carefree shimmy.

A contrast in patriotism

And then, of course, there was the version of patriotism on display in the arena. I’ve never seen so many representations of the Stars and Stripes in my life, classic flags everywhere and flag designs plastered on all manner of attire. Remember, I went to West Point. No one showed the slightest concern that many of the red-white-and-blue adaptations worn or waved strictly violated the statutes colloquially known as the U.S. Flag Code (United States Code, Title 4, Chapter 1).

That said, going undercover in Trumplandia means entering a universe in which it’s exceedingly clear that one political faction holds the flag hostage. They see it as theirs — and only theirs. They define its meaning, its symbolism, and its proper use, not to speak of whom it represents. The crowd, after all, was vanilla. (There were more people of color serving beers than cheering the president.)

By a rough estimate, half of the attendees had some version of the flag on their clothing, Trump banners, or other accessories, signaling more than mere national pride. Frequently sharing space with Old Glory were images of (often military-grade) weaponry, skulls (one wearing an orange toupee), and anti-liberal slogans. Notable shirts included: the old Texas War of Independence challenge “Come And Take It!” above the sort of AK-47 assault rifle long favored by America’s enemies; a riff on a classic Nixonianline, “The Silent Majority Is Coming”; and the slanderous “Go To Your Safe Space, Snowflake!”; not to mention a sprinkling of the purely conspiratorial like “Alex Jones Did Nothing Wrong” (with a small flag design on it, too).

The banners were even more aggressive. “Trump 2020: Fuck Your Feelings” was a fan favorite. Another popular one photo-shopped The Donald’s puffy face onto Sylvester Stallone’s muscle-bound physique, a machine gun at his hip. That image, of course, had been lifted from the Reagan-era, pro-Vietnam War film “Rambo: First Blood Part II,” a fitting accompaniment to Trump’s classically plagiarized Reaganesque rallying cry “Make America Great Again.” Finally, a black banner with pink lettering read “L G B T.” Above the letters, also in pink, were logos depicting, respectively, the Statue of Liberty, a Gun (an M16 assault rifle), a Beer mug, and a profile bust of Donald Trump. Get it?

For our small group of multi-war/multi-tour combat veterans, it was hard not to wonder whether many of these flag-and-weaponry enthusiasts had ever seen a shot fired in anger or sported Old Glory on a right-shoulder uniform sleeve. Though we were all wearing standard black veteran ball-caps and overtly Trump-friendly shirts, several of us interlopers feared the crowd might somehow guess what we actually were. Yet tellingly, the closest we came to outing ourselves — before later pulling off our disguises to expose black “About Face: Veterans Against The War” shirts — was during the national anthem.

Nothing better exemplified the contrast between what I’ve come to think of as the “pageantry patriotism” of the crowd and the more complex “participatory patriotism” of the dissenting vets than that moment. At its first notes — we were still waiting in the arena’s encircling lobby — our whole team reflexively stood at attention, removed our hats, faced the nearest draped flags, and placed our hands upon our hearts. We were the only ones who did so — until, at mid-anthem, a few embarrassed passersby followed our example. Most of the folks, however, just continued to scamper along, often chomping on soft pretzels, and sometimes casting quizzical glances at us. Trumpian patriotism only goes so far.

Our crew was, in fact, rather diverse, but mostly such vets groups remain disproportionately white and male. In fact, one reason local black and native communities undoubtedly requested our attendance was a vague (and not unreasonable) assumption that maleness, whiteness, and veteran’s status might offer their protests some semblance of protection. Nevertheless, my old boss on West Point’s faculty, retired Colonel Gregory Daddis, summed up the limits of such protection in this phrase: “Patriotic” Veterans Only, Please. And just how accurate that was became violently apparent the moment we “unmasked” at the base of those flagpoles.

Approximately three-dozen combat tours braved between us surely didn’t save our nonviolent team from the instant, distinctly physical rancor of the police — or four members of our group from arrest as the climbers shimmied those flagpoles. Nor did deliberately visible veteran’s gear offer any salvation from the instantly jeering crowd, as the rest of us were being escorted to the nearest exit and tossed out. “Antifa!” one man yelled directly into a Marine vet’s face. Truthfully, America’s “thanks for your service” hyper-adulation culture has never been more than the thinnest of veneers. However much we veterans reputedly fought for “our freedom,” that freedom and the respect for the First Amendment rights of antiwar, anti-Trump vets that should go with it evaporates with remarkable speed in such situations.

Three strands of veteran or military dissent

Still, the intensity of the MAGA crowd’s vitriol — as suggested by the recent hate mail both About Face and I have received — is partly driven by a suspicion that Team Trump is losing the military’s loyalty. In fact, there’s evidence that something is indeed astir in both the soldier and veteran communities the likes of which this country hasn’t seen since the tail end of the Vietnam War, almost half a century ago. Today’s rising doubt and opposition has three main components: retired senior officers, younger combat veterans, and — most disturbingly for national-security elites — rank-and-file serving soldiers and National Guardsmen.

The first crew, those senior officers, have received just about the only media attention, even though they may, in the end, prove the least important of the three. Many of the 89 former defense officials who expressed “alarm” in a Washington Post op-ed over the president’s response to the nationwide George Floyd protests, as well as other retired senior military officers who decried President Trump’s martial threats at the time, had widespread name recognition. They included former Secretary of Defense and retired Marine Corps General Jim (“Mad Dog”) Mattis and that perennial latecomer, former Secretary of State and Joint Chiefs Chairman Colin Powell. And yes, it’s remarkable that such a who’s-who of former military leaders has spoken as if with one voice against Trump’s abhorrent and inflammatory recent behavior.

Still, a little caution is in order before canonizing a crew that, lest we forget, has neither won nor opposed a generation’s worth of unethical wars that shouldn’t have been fought. Recall, for example, that Saint Mattis resigned his post not over his department’s complicity in the borderline genocideunderway in Yemen or pointlessly escalatory drone strikes in Somalia, but in response to a mere presidential suggestion of pulling U.S. troops out of the quicksand of the Syrian conflict.

In fact, for all their chatter about the Constitution, oaths betrayed, and citizen rights violated, anti-Trumpism ultimately glues this star-studded crew together. If Joe Biden ever takes the helm, expect these former flag officers to go mute on this country’s forever wars waged in Baghdad and Baltimore alike.

More significant and unique is the recent wave of defiance from normally conservative low- to mid-level combat veterans, most, though not all, a generation junior to the attention-grabbing ex-Pentagon brass and suits. There were early signs of a shift among those post-9/11 boots-on-the-ground types. In the last year, credible polls showed that two-thirds of veterans believed the wars in Afghanistan, Iraq, and Syria “were not worth fighting,” and 73% supported full withdrawal from the Afghan War in particular. Notably, such rates of antiwar sentiment exceed those of civilians, something for which there may be no precedent.

Furthermore, just before the president’s controversial West Point graduation speech, more than 1,000 military academy alumni signed an open letteraddressed to the matriculating class and blatantly critical of Trump’s urge to militarily crack down on the Black Lives Matter protests. Mainly ex-captains and colonels who spanned graduating classes from 1948 to 2019, they briefly grabbed mainstream headlines with their missive. Robin Wright of the New Yorker even interviewed and quoted a few outspoken signatories (myself included). Then there was the powerful visual statement of Marine Corps veteran Todd Winn, twice wounded in Iraq, who stood for hours outside the Utah state capitol in the sweltering heat in full dress uniform with the message “I Can’t Breathe” taped over his mouth.

At the left end of the veterans’ community, the traditional heart of antiwar military dissent, the ranks of the organizations I belong to and with whom I “deployed” to Tulsa have also swelled. Both in that joint operation and in the recent joint Veterans for Peace (largely Vietnam alumni) and About Face decision to launch a “Stand Down for Black Lives” campaign — encouraging and supporting serving soldiers and guardsmen to refuse mobilization orders — the two groups have taken real steps toward encouraging multi-generational opposition to systemic militarism. In fact, more than 700 vets publicly signed their names (as I did) to About Face’s provocative open letter urging just such a refusal. There were even ex-service members among the far greater mass of unaffiliated veterans who joined protesters in the streets of this country’s cities and towns in significant numbers during that month or more of demonstrations.

Which brings us to the final (most fear-inducing) strand of such dissent: those in the serving military itself. Their numbers are, of course, impossible to measure, since such resistance can range from the passive to the overt and the Pentagon is loathe to publicize the slightest hint of its existence. However, About Face quickly received scores of calls from concerned soldiers and Guardsmen, while VFP reported the first mobilization refusals almost immediately. At a minimum, 10 service members are known to have taken “concrete steps” to avoid deployment to the protests and, according to a New York magazine investigation, some troops were “reconsidering their service,” or “ready to quit.”

Finally, there’s my own correspondence. Over the years, I’ve received notes from distraught service members with some regularity. However, in the month-plus since George Floyd’s death, I’ve gotten nearly 100 such messages from serving strangers — as well as from several former West Point students turned lieutenants — more, that is, than in the preceding four years. Last month, one of those former cadets of mine became the first West Point graduate in the last 15 years to be granted conscientious objector status. He will complete his service obligation as a noncombatant in the Medical Service Corps. Within 36 hours of that news spreading, a handful of other former students expressed interest in his case and wondered if I could put them in touch with him.

Intersectional vets

In a moment of crankiness this January, using a bullhorn pointed at the University of Kansas campus, I decried the pathetic student turnout at a post-Qasem Soleimani assassination rally against a possible war with Iran. And it still remains an open question whether the array of activist groups that About Face and Veterans for Peace have so recently stood in solidarity with will show up for our future antiwar endeavors.

Still, the growth across generations of today’s antiwar veterans’ movement has, I suspect, value in itself — and part of that value lies in our recognition that the problem of American militarism isn’t restricted to the combat zones of this country’s forever wars. By standing up for Black lives, pitching tents at Standing Rock Reservation to fight a community-threatening pipeline, and similar solidarity actions, this generation of antiwar veterans is beginning to set itself apart in its opposition to America’s wars abroad and at home.

As both the Covid-19 crisis and the militarization of the police in the streets of American cities have made clear, the imperial power that we veterans fought for abroad is the same one some of us are now struggling against at home and the two couldn’t be more intimately linked. Our struggle is, at least in part, over who gets to define patriotism.

Should the sudden wave of military and veteran dissent keep rising, it will invariably crash against the pageantry patriots of Chickenhawk America who attended that Tulsa rally and we’ll all face a new and critical theater in this nation’s culture wars. I don’t pretend to know whether such protests will last or military dissent will augur real change of any sort. What I do know is what my favorite rock star, Bruce Springsteen, used to repeat before live renditions of his song “Born to Run”: Remember, in the end nobody wins, unless everybody wins.

Copyright 2020 Danny Sjursen

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Will the schools open? Behind that unanswerable question lies a national catastrophe

Here’s what we know about whether it’s safe or practical to send millions of American kids and teenagers back to school for the fall term, which in some districts begins in just over a month: Nothing. 

Parents, teachers, school administrators and elected officials are — I mean, pick your cliché: We’re lost. (I’m a public school parent in New York City, so I’ll go with the first-person plural.) We’re wandering in the desert without a map as darkness falls, or perhaps trying to find an invisible needle in a burning haystack, which is threatening to set the entire barn on fire. As Robin Cogan, a school nurse in Camden, New Jersey, told the New York Times: “It feels like we’re playing Russian roulette with our kids and our staff.” 

She’s right: It’s a “Deer Hunter”-style game of Russian roulette, played blindfolded under conditions of complete chaos. For reasons of their own, which are of course entirely self-interested and poorly thought-out, President Trump and Betsy DeVos, his Dickens-villain education secretary, are pushing all public and private schools to open all the way for all students, five days a week. Like every other Trumpian strategy relating to the coronavirus pandemic, that won’t work and is a terrible idea. Its only saving grace is that the federal government plays only a minor role in managing public education, which is one of those things a lot of liberals lament in more “normal” times and should be grateful for now.

One of the great ironies of this painful situation is that many of those liberals, for understandable and in many ways admirable reasons, are also eager to see schools reopen — and have put themselves in the darkly hilarious position of urging us not to reject the evil Trumpian plan just because it’s an evil Trumpian plan proposed by literally the worst people ever. And look, let’s agree on some stuff here.

It would be better for the mental and physical health and intellectual development of nearly all children for them to be in school. Hardly any kids have enjoyed sitting at home struggling with “online learning” models that almost entirely suck — and for many kids, especially those with special needs and those in low-income families or immigrant households, online instruction hasn’t worked at all. 

To state the obvious: People like me, or like my former colleague Michelle Goldberg, a prominent voice in the “schools must reopen” chorus — meaning middle-class parents with resources and options — are not bearing the brunt of this disaster. It sucks for us too, but one way or another, my kids and Michelle’s will be OK. (We don’t know the details of “OK” right now, which is distressing, but whatever.) Keeping kids out of school puts an unsustainable burden on all working families, but especially on working-class or poor families and communities of color. And that burden disproportionately falls on women, affecting their ability to make a living, pursue an education or build career opportunities. 

All of that is true and devastating and tragic. But that left-liberal social-theory worldview is exactly what led New York Mayor Bill de Blasio to delay closing the city’s public schools in March, a decision that quite plausibly cost thousands of lives. It has driven much of the New York Times coverage of this issue, which leans hard on the proposition — again, a defensible and understandable one — that public education is a foundational element of any social justice agenda. It fueled one of the most ludicrous Times editorials in that institution’s troubled recent history, which began by announcing that “American children need public schools to reopen in the fall,” and concluded by admitting that probably would not and could not happen on any large scale.

If you’ve been waiting since the first paragraph to inform me that in fact we know considerably more than “nothing,” and that there’s fairly strong evidence that young children don’t easily catch the coronavirus, tend not to get sick if they do catch it, and do not appear to spread it to others — thank you and, yes, that’s true. (When it comes to high school kids, the picture is nowhere near as clear.) But honestly, that argument — like the “public schools are central to democracy” argument — feels like a tangential issue right now, and a classic example of the liberal tendency to compartmentalize and avoid the bigger questions.

Yes, various other countries have reopened their schools, with greater or lesser degrees of success. That’s gone pretty well in most of Europe, although Hong Kong and Israel, two very different kinds of places, had to shutter the schools again after renewed outbreaks. But no other country, anywhere in the world, has tried to do the unbelievably stupid thing the United States is apparently about to do: Reopen the schools, in piecemeal, half-baked, “let’s put on a show” fashion, while the pandemic is still surging and has clearly not yet crested, and without any semblance of a national strategy to control it. 

There’s a central flaw in the left-liberal “schools must open” logic, which is so obvious we hardly ever talk about it. All of this rests on the fundamental assumption that a neoliberal “market” economy is the natural order of things, and that real solutions that might make this situation manageable for parents, students, teachers and employers are simply off the table. Another kind of society might have a national child care policy and a national health care policy in place, which might require some emergency augmentation but would already be there. It might authorize direct, continuing payments to parents forced out of work because their kids are at home — or, what the hell, even to parents who can continue to work from home but would like to preserve what remains of their sanity and occasionally get some sleep.

We appear to be stuck in a circular conundrum, which everyone can perceive but no one can fix: Kids have to go to school because their parents have to go to work, because that’s the only way society can possibly function — but none of that stuff is possible amid a massive public health emergency that seems to be getting worse rather than better, especially under a federal government whose official policy is that reality does not exist.

Given all that, what will actually happen? Nobody knows, but it won’t be good. Most big school districts, including New York’s — by far the largest in the country — are trying to cobble together some version of “blended” or “hybrid” learning, which means a combination of limited, socially-distanced in-person instruction and the largely disastrous online-learning experiment of the spring. 

Some districts in especially hard-hit areas, including Miami and Phoenix, have made clear they will almost certainly begin the year with online instruction only — and as inadequate as that is in educational, social and psychological terms, I can’t see how they could make any other choice. In Palm Beach County, the president’s nominal place of residence, officials have said the entire school year will probably be online — and if that’s not a giant FU to the lord of Mar-a-Lago, I don’t know what would be.

But the bigger picture isn’t even as coherent as that sounds. Most school districts still have no idea whether they’ll open the doors in the fall, or to what extent, or whether any of their throwing-spaghetti-at-the-wall instructional plans will actually work. The teachers union in Los Angeles, the second-largest district in the nation — and one of the worst pandemic hotspots of the summer — has officially called for schools to remain closed in the fall, with the overwhelming support of its membership. With Mayor Eric Garcetti clearly on the verge of ordering another shutdown, it appears unlikely that any L.A. students will attend school this year.

A hundred miles south in San Diego, officials not long ago confidently announced a “detailed plan,” developed in consultation with public health experts, that would allow them to reopen all schools at the end of August. But that was during the moment of California hubris, when the state appeared to have weathered the COVID storm and begun moving into a measured reopening. Over the last week or so, San Diego County has reported about 500 new cases a day, and dozens of uncontrolled “community outbreaks.” The teachers union there has gently expressed “concern” that the school district’s plan does not appear to involve smaller class sizes, improved ventilation or increased testing capacity — and that there’s no funding for any of that stuff. 

Teachers unions in New York, Chicago and other large cities haven’t taken clear positions yet, but the possibility of a widespread refusal to return to work appears very real. There’s a growing sentiment among teachers, principals and many elected officials that schools should not even try to reopen in any given locality until coronavirus case numbers are declining and “community spread” is clearly under control. Houston Mayor Sylvester Turner put it succinctly over the weekend: “It makes no sense” to consider sending children in his city back to school, given the scale of the current crisis. Under that standard, probably only the Northeast Corridor states would currently qualify for reopening — but given the horrific experience those of us in the New York metropolitan area endured through the early spring, there’s not much appetite for taking on unknown risk.

Who wants to stand up right now and tell me that this is the greatest nation in the world? Because that has gone from highly debatable to an objectively cruel falsehood. Along with all the conflicting arguments and ambiguous public-health evidence, we face the transmutation of what ought to be a straightforward (if challenging) question of social policy into a culture-war issue — because absolutely goddamn everything in 2020 America has to be a culture-war issue. (I stood in a supermarket in upstate New York this weekend looking at the stacks of beer cartons on the floor and realized that they presented a culture-war issue: Coors Light, or some overpriced, overly-hoppy IPA with zany graphics on the box? If there’s a neutral space in that conflict, it’s probably Heineken — which was sold out.)

The fact that we do not have the slightest f**king idea how to send 60 million-plus American kids back to school safely amid a worsening pandemic isn’t just an inconvenience, or an impediment to a return to economic normalcy — which is just not a thing we can have right now, people, and pretending it might somehow be possible is not helping. 

It’s a social catastrophe whose effects will be far-reaching and unknowable. It’s a national humiliation, one of many in this period of rapid American decline or implosion. It’s a giant flashing ALL-CAPS sign, directed at adults of all backgrounds and dispensations and political parties, informing us that we have failed in our primary responsibility of creating the best possible options and opportunities for those who will still be here when we’re gone.

Cuomo’s report on new nursing home policy for COVID patients prompts more controversy

In defense of a controversial policy to send COVID-19 positive patients from hospitals into nursing homes, New York Gov. Andrew Cuomo’s health department issued a report on Monday saying that the directive did not significantly contribute to the nearly 6,500 deaths that have occurred to date in homes across the state.

Howard Zucker, commissioner of the New York State Department of Health, said at a news conference that sickened staff members were the chief source of infection for residents at the state’s more than 600 nursing homes. He said some 37,500 workers at the homes — nurses, administrators, maintenance staff — had tested positive for the virus since the pandemic began to sweep through the state.

The report said the staff members “transmitted the virus unknowingly — through no fault of their own — while working, which then led to resident infection.”

In the days since its release, the report has come under withering criticism, from some nursing home executives, medical experts, scientists, and elected officials in both New York and Washington. The critics have challenged the report’s conclusions as dubious speculation and accused Cuomo and Zucker of issuing a cynical document meant to insulate themselves from blame.

“I don’t think this report convincingly demonstrates that the policy was not another important driver of deaths,” said Denis Nash, an epidemiologist and executive director of the CUNY Institute for Implementation Science in Population Health. “The key consideration here is a question of ‘what if.’ What if there had been no such policy. … Would there have been fewer deaths? How many fewer? … They didn’t fully leverage epidemiological methods to rigorously address that question, in my view.”

 

On March 25, Cuomo, saying he feared that an onslaught of COVID victims would overwhelm hospitals, issued an order that required nursing homes to accept COVID-19 patients being discharged from hospitals, so long as they were “medically stable.” Under the policy, the nursing homes receiving the patients were barred from testing the patients to see if they might still be contagious.

As ProPublica reported last month, New York’s nursing homes suffered a larger percentage of deaths relative to its total nursing home population than several states that did not have such a policy in place.

The state’s directive infuriated many health experts, families of residents and nursing home operators who said they were already ill-prepared and struggling to keep residents safe amid the growing COVID threat. They worried that the policy would needlessly lead to additional infections and deaths inside the homes.

Cuomo ultimately rescinded the policy on May 10, after more than 6,000 residents had died and the fears about overwhelmed hospitals had faded. At the time, Cuomo also implemented a range of measures to protect nursing home residents, including routine testing of all staff.

In its report, the health department minimizes any role the admissions of COVID patients might have played in the spread of disease in the homes, citing a review of data made available by the nursing homes themselves.

The report asserts that the majority of the more than 6,000 admissions of COVID patients occurred after the deadliest days at the homes. It says that some 80 percent of the homes that took in COVID patients had already seen either staff or residents infected. It also says that many of the COVID patients sent to the homes were likely not still contagious.

“If you were to place blame,” Zucker said of the number of people who died inside nursing homes, “I’d blame coronavirus.”

Michael Dowling, chief executive officer of Northwell Health, the largest hospital organization in the state, appeared at the news conference with Zucker and endorsed the report’s conclusions.

At the conference, he said the “study confirms what we saw in our own facilities around the state: that when the virus hit our local communities, it quickly spread through asymptomatic carriers into our nursing homes, hospitals, places of worship and other congregate settings.” But he did not respond to further questions for this story.

The report asserts that the highest number of nursing home staff reporting symptoms occurred on March 16, nine days before the controversial directive was issued. The peak number of reported nursing home fatalities, the report said, was reached April 8. The report uses the timeline to conclude that workers at the home were the ones driving infections and deaths.

To bolster that claim, the report says that the greatest numbers of daily COVID patient admissions did not occur until later in April.

“If admissions were driving fatalities, the order of the peak fatalities and peak admissions would have been reversed,” the report concludes.

Rupak Shivakoti, an epidemiologist at Columbia University’s Mailman School of Public Health, said a fundamental flaw with the report was that while infected workers at the homes might have been a major driver of infections and death, the report deals almost not at all with whether the admissions of COVID patients added to infections and deaths.

Indeed, while April 8 may have been the single deadliest day for nursing home residents — roughly 250 died — more than 4,000 additional residents would perish in the days and weeks to come as thousands of COVID patients continued to arrive at the homes.

“Their data needs to be much more convincing than just saying the peaks of the nursing home health workers infection matched a later peak of mortality,” Shivakoti said.

Catherine Troisi, an infectious disease epidemiologist at the UTHealth School of Public Health in Houston, also said this conclusion amounted to speculation on the part of the state.

“It certainly is circumstantial evidence,” she said. “There’s no way to provide causality.”

John Rowe, former CEO of health insurance giant Aetna and a Columbia University professor of health policy and aging, however, defended the state’s report as “pretty solid.” In an email, he said it contained “rather detailed analytics, lots of testing data, a large sample of nursing homes” and other important findings. He added that ProPublica could consider his opinion a “peer review, the term used by academic journals for the process of independently assessing research before publication.

Christopher Laxton, executive director of the Society for Post-Acute and Long-Term Care Medicine, has criticized the state’s policy as having been enacted without adequate input from experts in nursing home health care. He told ProPublica that the report amounted to “defensive politics on the part of the governor.”

He told ProPublica that the report amounted to “defensive politics on the part of the governor.”

In Washington, Rep. Steve Scalise of Louisiana, the Republican leader of a House subcommittee focused on the COVID crisis, said the report was consistent with Cuomo’s unwillingness to take responsibility for a misguided and deadly policy. Scalise has demanded that Cuomo turn over records related to the policy and the outcomes at the state’s nursing homes, but Cuomo has so far refused to do so.

“Disgusting,” Scalise said of the report.

On Thursday, Scalise sent a letter to Cuomo, urging his compliance with the congressional inquiry and saying many parts of the state’s report were “divorced from science.”

“NYSDOH’s report appears to be little more than your administration’s latest attempt to deflect criticism and shift blame for the consequences of your deadly nursing home order,” the letter said. “But blame-shifting, name-calling and half baked data manipulations will not make the facts or the questions they raise go away. The families of those affected by your March 25 order deserve answers about why it was put in place and, rest assured, we will not give up until we get those answers.”

Rich Azzopardi, an adviser to Cuomo, dismissed Scalise’s request for documents as partisan grandstanding, and mocked the idea that Republican lawmakers in Washington had much respect for science.

The health department’s report was done with the aid of the consulting company McKinsey & Co. The report says it drew on data collected from nursing homes through surveys. It does not list a single author by name, in or out of the health department. McKinsey itself is only listed in a footnote. The health department’s website lists four independent reviewers, none of whom are epidemiologists. Two are hospital executives: Michael Dowling, the Northwell hospital chain CEO, and Dr. David L. Reich, president and chief operating officer of Mount Sinai Hospital. Neither answered emailed questions for this story. The health department would not say who, exactly, authored the report, or how much it paid McKinsey for its involvement. McKinsey declined to comment for this story, but did not cite a reason.

“We will not have any comment. Thank you for reaching out,” DJ Carella, a spokesman for the company.

In determining that COVID patients discharged from hospitals could not have been a significant threat, the report says 252 of the 310 homes that received those COVID patients already had noted infected staff or residents.

The report seems to suggest that adding more COVID positive patients to those 252 homes did not increase the risk to the staff and residents.

The report is silent on a seemingly important question raised by its own data: Some 58 nursing homes did not have a single case of a sickened staff member or resident prior to the arrival of a COVID patient from the hospital. The report does not say how many, if any, residents or staffers at those homes became sick or died.

Asked by ProPublica about those 58 homes, Jonah Bruno, a spokesman for the health department, would not answer.

“They won’t address what happened when they sent COVID patients to homes with no COVID because it’s damaging to their false narrative,” said Steve McLaughlin, the Rensselaer County executive.

McLaughlin has publicly warred with Cuomo since the March 25 directive was issued. He refused to allow COVID patients into the nursing home run by the county, and the 300-bed facility has not had a single case of COVID. At Diamond Hill, a private nursing home in the county that took in four COVID patients, 18 residents died.

“The entire report is a whitewash and a sham,” McLaughlin said.

Bruno, the department spokesman, did not respond when told of McLaughlin’s claims.

The report, in arguing that the COVID patients did not add significantly to the death tolls, said that the COVID-19 positive patients were admitted to nursing homes at a median of nine days after hospital admission. The report claimed that most health experts agree such patients would no longer be infectious at that point.

In fact, the science on the length of infectiousness is still unsettled. The CDC, on its website, says just that.

Denis Nash, the CUNY epidemiologist, said the state’s own claim meant that roughly 3,000 COVID patients were sent to nursing homes within nine days after admission to the hospital, so by the Cuomo health department standard, many patients were still potentially contagious.

Nash said that it would be useful to know how many patients were sent to nursing homes one, two or three days after admission, when they were likely more infectious.

Shivakoti, the epidemiologist at Columbia, agreed.

“While ‘most’ of the patients were likely not contagious, at least at the peak of times, there might have been a small percentage who were,” he said. “Due to the easy spread in nursing homes, this is still a risk.”

Bruno did not respond when asked why the state chose to use the median as its metric.

The report compares the timing of peak deaths to peak admissions, but it reflects no effort to trace the path of viral transmission: There is no indication that the investigators tried to identify workers or the residents they cared for, or who may have given the virus to whom.

Jim Malatras, an adviser to the governor on the coronavirus response, seemed to concede its imperfections in a remark to a reporter for City and State.

“All you can do is measure things, and then point out the strongest factors,” he said, acknowledging that the science on how long someone can be infectious remains in flux. “If you put a gun to my head and say: You know with 1 million percent certainty?’ Of course not.”

ProPublica first contacted the health department on Monday with questions about the report, and asked for an interview with Zucker and some of the underlying data behind the report’s conclusions. Four days later, Bruno, the department spokesman, had not answered the questions or provided the data.

The state report says that “over the course of the crisis, New York State provided nursing homes with an unprecedented 8,510,729 pieces of PPE for their workers and others.”

The New York State Nurses Association believes that figure is deceptive and that the state provided too little too late. The association tried to sue the Department of Health earlier this year over its failure to provide sufficient protective gear to nurses in both hospitals and nursing homes. The lawsuit was ultimately dismissed because a federal judge said the association lacked standing.

In a letter released on Friday, the association said:

“New Yorkers deserve a full accounting of what happened over the past four months, and the NYSDOH nursing home report, unfortunately, does not move us forward. The need is plain for a comprehensive, independent review of nursing home practices, the role of for-profit operators, and NYSDOH oversight.”

Richard Gottfried, the Democratic chairman of the New York State Assembly’s health committee, has already called for such an independent investigation.

“The report seems accurate as far as it goes, but also somewhat beside the point if we are interested in determining the specific consequences of the governor’s March 25 directive,” Gottfried said. “The question about the order is not how the virus first got into the nursing homes. It’s whether patients returning from the hospital were still contagious, and what should be done if the patient is still contagious. The report was done by the head of the department under scrutiny, and endorsed by two hospital executives with close ties to the department. I respect all three. But the report would have been more valuable and reassuring if it came from independent medical experts, preferably academic.”

The state report argues that New York compared favorably to other states with respect to its nursing home death toll. It cites a New York Times analysis that found that New York “ranks 46th in the nation — meaning 45 states had a greater percentage of fatalities.”

But that ranking is based on the number of nursing home deaths relative to each state’s overall death count, not each state’s nursing home population.

By that count, New York might fare much worse.

As ProPublica reported last month, New York lost about 6% of its more than 100,000 nursing home residents. New Jersey, which had a similar policy, lost roughly 12% of its more than 43,000 residents. In Florida, where such transfers were barred, just 1.6% of 73,000 nursing home residents died of the virus. California briefly had a similar policy in place but then revised it, losing 2% of its 103,000 nursing home residents as of mid-June. Louisiana had stricter rules and lost 4 percent, suffering 1,075 deaths out of 26,000 residents.

Any state-by-state comparison is difficult to make because many states count deaths differently. New York, for example, does not count the deaths of nursing home residents in hospitals as nursing home deaths, as many other states do.

In defending its policy, the Cuomo administration has stressed that nursing homes incapable of safely caring for COVID patients could have declined to accept them. Several nursing home experts have said many homes feared denying admissions because of the state’s directive.

Shivakoti of Columbia said he thought it would have been preferable for the state, along with doctors and hospitals, to have decided where COVID patients could have best been cared for.

“All this was likely difficult to do for the first wave but can be planned for the subsequent waves,” he said..

Tamara Kanetzka, a University of Chicago professor of public health sciences, said that the New York mandate to send COVID-19 patients to nursing homes was “misguided,” and that certain aspects of the report were speculative or disingenuous.

But she accepted that staff members were likely the single greatest source of infection at the homes.

What is beyond dispute, however, is that county, local and federal authorities had “grossly failed nursing home residents nationwide and probably will continue to do so as the virus surges in much of the country,” she said.

“We need to stop finding people to blame and try getting resources and assistance to nursing homes located in the new virus hotspots,” she said.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

“You can’t do that”: Betsy DeVos gets schooled by Fox News host

Fox News host Chris Wallace on Sunday challenged Trump administration Education Secretary Betsy DeVos over a threat to cut off funding for schools that do not agree to gathering students together during the coronavirus pandemic.

“Both you and the president have threatened to cut off funding for schools systems that don’t open fully in the fall,” Wallace explained during an interview with DeVos. “Are you and the president unilaterally going to cut off funding that’s been approved by Congress — and most of the money goes to disadvantaged students or students with disabilities?”

Wallace continued: “And secondly, isn’t cutting off funding exactly the wrong answer? Don’t you want to spend more money to make schools safer, whether it’s with plastic shields or health checks, various other systems?”

“Doesn’t it make more sense to increase funding for schools where it’s unsafe rather than cut off funding?” he asked.

DeVos doubled down on her threat to defund the education system.

“If schools aren’t going to reopen and not fulfill that promise, they shouldn’t get the funds,” the education secretary opined. “Then give it to the families to decide to go to a school that is going to meet that promise.”

Wallace pointed out that a public health emergency is not the time to push a longtime Republican-led effort to favor private schools over public schools.

“You can’t do that!” the Fox News host said. “I know you guys support vouchers and that’s a reasonable argument but you can’t do that unilaterally, you have to do that through Congress.”

“Well, we’re looking at all the options because it’s a promise to the American people and their families,” DeVos remarked. “And we want to make sure that promise if followed through on.”

Watch the video below from Fox News.

“The Old Guard”: Gina Prince-Bythewood on superhero diversity, that ending & sequel possibilities

Connecting with what defines and drives a superhero requires knowing her origin story. The same concept applies to people like Gina Prince-Bythewood, a veteran of TV and film who has made history in directing Netflix’s “The Old Guard,” an unconventional superhero tale starring Charlize Theron and KiKi Layne.

Helming this new movie makes Prince-Bythewood the first Black woman to direct a major superhero film, a distinction she was already on target to achieve when she was attached to direct the Marvel Cinematic Universe film “Silver & Sable.” She’s still attached to that project, which has since been reconsidered as a series instead of a feature.  

But to understand why it was so important for Prince-Bythewood to steer “The Old Guard,” which casts Theron as Andromache the Scythian, a 6,000-year-old warrior who goes by Andy, look back to the year 2000 and the director’s cinematic debut “Love & Basketball.”

Very different films, certainly. And yet Monica, the romantic heart of “Love & Basketball,” shares more than a few similarities with KiKi Layne’s Nile, the co-lead in “The Old Guard.” The movie is based on a graphic novel series created by Greg Rucka, in which Nile, a United States Marine, suddenly has immortality thrust upon her. Nobody can explain the why or how of it – not even Andy or her companions Booker (Matthias Schoenaerts), Joe (Marwan Kenzari) and Nicky (Luca Marinelli), each of whom has been around for 100 years and cannot be killed.

Immortality sounds like a hell of a superpower to anyone who doesn’t have to actually live through it, and while Nile is new to grappling with that idea, others in the group are long past sick of living. (And in the case of Quynh, played by Veronica Ngo, she lived through multiple drownings after being trapped in the ocean for centuries, but shows up dry and very much alive at the very end.)

The novelty of Nile, though, cannot be overstated. In playing her, Layne, who earned critical acclaim for her performance in “If Beale Street Could Talk,” becomes one of very few women of color to portray a superhero in a movie. This is why Prince-Bythewood pushed for Nile’s character to have a more central role on the screen than Rucka originally wrote for her in his pages. 

She did that for the same reason that she created Monica in “Love & Basketball”; she rarely if ever saw an ideal version of herself on small screens or big. What that meant, she remembers, was “I never felt like anyone’s ideal. I was always made to feel like something was wrong with me in the fact that I liked sports, that I was athletic, that I didn’t wear makeup, you know. That fact I just always felt less desired.”

She’s since come to realize what was missing was a fictionalized ideal for her to look up to, that of a warrior and another phrase she uses frequently, a “badass.”

“Being female is not just one thing, and showing that breadth of who we can be and the differences within that, that shouldn’t be denigrated,” she told Salon in a recent and wide-ranging interview.

In it, she also discussed her goals for how Andy and Nile are rendered in “The Old Guard,” the ways in which she seeking to reframe the comic book film’s portrayal of women, the creation of the character Quynh, and thoughts on continuing this story. The following interview has been lightly edited for length and clarity.

It’s rare to come across a superhero title that is different from the big studio franchise candy that’s been coming out in theaters recently. But let’s step back a little bit and talk about the road to bringing it into being in the first place. Throughout your career, you’ve had a very specific visions as a director, and fought very hard for them. So I’m wondering, how much of a battle it was to bring this specific vision of “The Old Guard” to fruition in comparison to some of your past titles?

It’s interesting. You know, I’ve written the majority of what I’ve directed in my career. And I knew that I wanted to move into this space. I mean, I love action films, I love comic book films, and I wanted the opportunity to help me bring my aesthetic to that. When the script came from Skydance, it had everything that I feel like if I had written it, this is what it would feel like. That’s what excited me so much.

So much of the storytelling – you know, the fact that it was this group of warriors from different backgrounds and cultures and sexual orientations and genders that have come together to do good for humanity. The fact that two women were at the heart of it, and one is a young black female warrior, you know. And this lovely love story was in it with Nicky and Joe. It just felt like it touched on all the things that I love to do as a filmmaker and an artist.

And finally, at the end of the day, for me, I want to hopefully create something that you connect to as an audience and moves you. And these characters move me: the thirst that they had for purpose, and the questions of, “Why are we here?” And, “What good are we doing for the world?” Those are things that I’ve struggled with and thought about. And so the fact that I could connect on a personal level was definitely the biggest reason why.

What were some of the things that you wanted to bring to “The Old Guard” that perhaps hasn’t been seen or that you haven’t seen and wanted to see, in other superhero films?

Certainly I wanted to look up and see myself reflected in a contemporary way. I wanted to see women who were not hyper-sexualized, who are badass. “Badass” for me is swagger, strength, vulnerability, empathy. Like, those are the things that I love in badass female characters. I wanted to see really a group of characters who reflected the world that I see every day – a very organically diverse world. And I wanted these characters to have depth and be about something. I wanted the audience care about the characters and not just the action set pieces. And so in saying that, that’s not to say that those films haven’t happened. They’re just very rare.

I loved “Wonder Woman.” The feeling of sitting in the theater and looking up at her as a female warrior was such a transformative feeling for me even now in this day and age. I realized how rare it was that I got to see that. And “Black Panther,” oh my God, just so changed the game and changed culture. The pride it brought me, the pride that it gave to my two boys, the fact that both Killmonger and T’Challa were heroic to them. I just love the direction that movies have gone in over the last couple of years, of becoming action dramas, as opposed to just action. And that’s certainly what I wanted, the ability to have the quiet moments be as important as the big set pieces.

It’s interesting that you bring up those two movies. Those are actually two of the movies that I thought of when I watched “The Old Guard.” I watched it twice actually, and what struck me during the second viewing was that quality in the script of focusing on these heroes who question whether their singular acts are having any impact on the larger world.

When you were looking at the original script for “The Old Guard,” and how much were you able to shape it in the direction of posing those larger questions, or did that  required such sculpting at all? So many of Andy’s questions are central to the plot’s eventual outcome.

It’s certainly in the graphic novel and definitely in the script, given that Greg Rucka adapted it himself. 

I love the character of this warrior who’s 6,000 years old and is at a point where she wants it all to end. Here’s someone who is mostly immortal, who essentially can’t die but wants to die because [she’s asking], “Why am I here? I have no impact. I’m tired.” That just felt so interesting and relatable to me.

One of the things that was important for me to add to the story, which Greg was absolutely open to doing was, you know, just adding this level of what killing means and the toll of killing.

You know, for “The Old Guard,” their mantra really is “kill one to save many.” And that’s, you know, something that you can wrap your head around. Yet, what does that truly mean in terms of how many people they’ve killed throughout the years?

I wanted that killing to have an impact on them, and so really bringing that both with Andy, but also Nile, who has her first kill within the story – letting an audience know that it’s not an easy thing, that taking a life is psychologically damaging.

I didn’t want to treat the violence or death as an easy thing within it. So adding that layer, I felt, was really helpful certainly to Andy and all the characters.

How were you able to do that? Was there any process that you had the actors go through?

I got that information from this great book that I read during my preparation to shoot this. It’s called “On Killing.” And it talks about how for soldiers, how taking a life is as damaging psychologically as your fear of losing your life on the battlefield.

In reading that book, I pulled all these key moments within the book and then shared that the actors, just so that they could read real things from soldiers and what they went through. Those were really good conversations. And there were a couple podcasts that I listened to about snipers. One was a man and one was a woman. And the toll that killing took on them, just to hear from these real people, what it takes to kill, was really fascinating for me hear, and then to be able to share with the actors,

Let’s talk a bit about how the character of Nile shaped up in “The Old Guard,” and this question comes from the perspective of a Black woman who grew up reading comics. When people would ask me, I would tell them my favorite comic book hero was Storm from “X-Men.” Storm is amazing, but for a long time Storm also was pretty much all Black girls had in terms of representation. So I’m wondering if you had a favorite superhero before making this movie, and whether elements of that character became part of Nile’s development.

Growing up there actually wasn’t a specific superhero that I gravitated towards except, you know, Spider-Man. I dug Spiderman. But in terms of a Black female hero that wasn’t in my consciousness, which is what I love about what is happening now with “Black Panther,” with “The Old Guard.” And with, you know, Storm. Certainly there’s a lot of percolating, you know, about that character getting a film.

I didn’t really have a template growing up of that, but it was exciting to me in reading “The Old Guard” and seeing that this character was there.

What was important to me – and again, what Greg was actually open to do – was elevating her character. I really wanted this to be Andy and Nile’s story. I wanted their relationship and what the two of them were going through simultaneously, but also affecting each other’s trajectory, absolutely I wanted that to be at the forefront.

I wanted to make sure that Nile had a full backstory, had a full arc, that she was integral to the climax and to the plot. And that was something that was missing a bit in the graphic novel.

But Greg had recognized that on his own. I had started working towards that when he got to the script stage. And then when I came aboard, that was something that he and I really worked on a lot. I wanted to see that character, I wanted to put another young Black female hero into the world, and it was certainly important to KiKi as well . . . because so many of us haven’t had that hero to look up at when we were little girls, and aspire to be.

I’m going to cue in on a word you’ve used a lot, which is “warrior” – and partially I’m asking about this because I just wrote about the fact that there’ve been so many stories over the years featuring white women as warrior heroes and so few featuring Black women.

When you think about, two of the most prominent recent Black female warriors that come to mind are played by Danai Gurira: Okoye from “Black Panther” and Michonne from “The Walking Dead.” There aren’t that many others onscreen besides those two. I’m wondering if you, as a director, have any ideas as to why it’s taken so long to open up the range of who gets to portray these heroes to not just Black women, but women of color in general.

It’s hard to say that it was deliberate, but it’s hard not to think it’s deliberate: the erasure, the invisibility of Black women in stories that Hollywood puts out. And it’s not enough that it might be a Black woman as, you know, the third or fourth characters. In terms of us being centered in stories and in different stories that show the breadth of our humanity, that has just not happened.

Given the rooms that I’ve sat in and the nonsense I’ve heard from studio execs, I think foremost, they just don’t connect to it. And so they have no desire to put money or time or thought behind that.

They see themselves in “Iron Man” even though – give me a break, you know? But they see themselves in that character. Or they see themselves in “Joker.” They don’t see themselves in Storm. And so if they’re not seeing themselves, their assumption is, “Well, nobody else is going to care either.” That’s what’s so damaging, that as opposed to, “I may not have lived this character’s life, but I can see the value in this person’s life.”

They haven’t seen our value, and it’s incredibly disheartening.

Because it’s so important for us to be able to see ourselves in a way to be inspired by and aspire to be, but for the world to see that too. When the world can see our humanity, you know, on film and television, then you hope and pray that that translates to real life. Obviously it’s no mystery. The way that we are treated, so much of that is because for decades on decades people were fed a narrative about us, whether it be a negative narrative that weaponizes our Blackness or an invisibility where we don’t exist.

And it’s been tough and it’s gonna take decades to rectify it, but let’s start now and put more of us up on screen in these roles with Black folks behind these narratives.

That segues into my next question about the backgrounds featured in “The Old Guard.” Greg’s choices seemed very intentional in terms of their respective eras and the people what they represent. With that in mind, I want to talk about Quynh. I hadn’t read the comic before watching the film, so I’m wondering if she was in there and if so, and what era she would have been from.

In the graphic novel, the character is named Noriko and she’s Japanese. When I started casting we cast a wide net in terms of Asian actresses, and Veronica [Ngo], she was great. I was excited about her.

It was just a thing foremost for me, but then also Greg, that we wanted the characters up on screen to be reflected truthfully in terms of their nationality. And so, once I knew that Veronica was really the one, I talked with Greg again to make sure that it could make sense. What era did she come from? Could she had been around when Andy found her a couple thousand years ago?

And he did the research that he does with all of his characters, and it absolutely did have a perfect storyline that worked in terms of when she would have been alive and the culture that she was in. So we wanted to make sure it was truthful to Veronica and then truthful to the story. [Editor’s note: Vietnam’s history includes a tradition of prominent warrior women.] And I wanted to honor the character. . . . she has such an interesting trajectory in the film.

Without giving away any spoilers, are there aspects of the story that maybe didn’t make it into this film that you in broad terms would like to see in future installments? Or have you even thought ahead that far?

Quynh’s character obviously has a big part in the future. The one thing that was in the graphic novel and in the original script that we couldn’t do – it was really a time thing, and a question of focus – what I would obviously love to see everyone’s backstory of how they came into being an immortal. Ultimately we decided we’ve got to focus on Andy on this one. But in the graphic novel with Nicky and Joe – those two, the way that they meet is so great.

It would’ve been so much fun to shoot and it’s just so visually stunning and emotional. And so I hope that if we gets another film, that that is certainly part of the story.

The ending leaves the possibility very open for future installments. If a sequel gets greenlighted, would you be open to coming back and directing again?

Foremost it is absolutely up to the audience . . . you just never know. I hope that the audience loves it and wants to see more. It was very important that the film itself has a beginning, middle, and end because I get annoyed by movies that leave things wide open. This was absolutely part of what the graphic novel was and how it ended.

Like, as someone in the audience I want to know what happened, ultimately. So I did love that bit of a tease. But it is up to the audience. Greg has always envisioned it as a trilogy, in terms of this graphic novel. So if the story gets to continue, you know, there’s certainly more stories to tell.

How to differentiate coronavirus vaccine news from hype

Every week since the start of the pandemic has brought new headlines about a coronavirus vaccine. In early June, there was news about human trials starting for a Johnson & Johnson vaccine; also in June, a vaccine made by Moderna was supposedly reaching “phase 3 trials,” the last phase in a drug development before government approval. Just this week, Novavax, a vaccine development company headquartered in Gaithersburg, Maryland, made news headlines for inking a $1.6 billion public-private agreement as part of the Health and Human Services’ Operation Warp Speed, which aims to deliver 300 million doses of safe and effective vaccines in 2021 in a collaborative effort with the private sector.

The constant updates from different companies as to vaccine creation certainly make for hopeful headlines. But for those of us laypeople lacking an immunology degree, it can be hard to filter what is important, and what is merely PR spin or sensationalist fluff. Moreover, for-profit pharmaceutical companies have a vested financial interest in advertising their vaccines as near-complete, even when they are not; such news inflates their stock and pleases investors. 

Separating spin from fact

According to The New York Times’ COVID-19 tracker, there are more than 145 vaccines being developed worldwide; 21 of those vaccines are in human trials. The vaccine landscape is certainly noisy, which is why it can be difficult to differentiate what is news about actual progress and what is being overhyped in the media.

“There are so many vaccine candidates, this is unprecedented,” Bunny Ellerin, the Director of the Healthcare and Pharmaceutical Management Program at Columbia Business School, told Salon. “Never before have so many organizations wanted to produce a vaccine.”

Dean Blumberg, chief of pediatric infectious diseases and associate professor in the Department of Pediatrics at the University of California–Davis, told Salon that any news that stems from a company’s press release, especially that which lacks any sort of associated data or a submitted publication with it, he tends to ignore those announcements. However, Blumberg said he takes notice of announcement when it is accompanied with data about the potential vaccine.

“So if they say we measured the immune response and here’s a table that shows the immune response time 28 days after immunization versus baseline, that’s actual data and that’s more interesting,” Blumberg told Salon. He added that the best case scenario in identifying real progress with a vaccine is where a company has released a preprint of research that’s been submitted to a journal for publication.

“Even before it’s been peer reviewed, and accepted for publication, you can at least look at it and make your own assessment of the quality of the data and the meaning of the data, put it into perspective,” Blumberg explained. “The highest quality is obviously once it has been peer reviewed and accepted for publication, even if it hasn’t been published yet,” he added.

What do the “phases” of vaccine trials mean? 

Ellerin told Salon that news consumers should pay attention to what clinicians are saying about vaccine news — particularly, clinicians who don’t have financial stakes in any relevant pharmaceutical companies. 

That said, there are still set processes that each pharmaceutical company must follow. These start with a preclinical trial, and then moves through three phases of testing before being approved.

“Phase I is very tiny — it’s called ‘the safety trial’ with a small number of participants just to make sure it’s safe,” Ellerin explained. “Phase II is a larger number of individuals. . . it focuses on both safety and efficacy, but it’s not huge.”

Phase III is the “pivotal trial,” Ellerin said, explaining that it tests thousands of people. By phase III, often the efficacy of the vaccine is “almost,” but not entirely there.

Finally, Phase IV occurs when the vaccine is approved by the Food and Drug Administration (FDA) and is in the market.

From start to finish, it usually takes five to eight years to move through the testing trials and make the vaccine available to the public. As of July 8, only four companies are in Phase III.

How long will it take? 

Ellerin said that a vaccine has never been created so fast as it has with the coronavirus. Thus, it is certainly possible that a vaccine will arrive much sooner, mainly because companies are “parallel processing,” as Ellerin says. Parallel processing a vaccine means that a company or institution works on multiple phases at once — for instance, recruiting volunteers for Phase III when you’re still in Phase I — in order to speed up the process.

Ellerin said that this process makes her hopeful that a vaccine will be in the market next summer.

“There are so many companies working on this that I have to believe that we will have it by next summer,” Ellerin said.

Blumberg told Salon that he is also hopeful there will be a vaccine available in 2021, hopefully by next summer, in part because the coronavirus is so widespread that many people who have test vaccines will be exposed to it. 

“There’s enough virus circulating that you can actually do the studies that prove that [a vaccine] works,” Blumberg said. He noted that there is concern over the rare side effects that vaccines often have. “I think we need the studies that prove that [a vaccine] is safe even from any rare side effects; we all know that there’s a lot of vaccine hesitancy out there.”

One poll found that only half of Americans would get a coronavirus vaccine. Blumberg said such a scenario could make it hard to achieve herd immunity, for which he says we will need somewhere between 70 and 90 percent of the population immune.

“Yet about 5 percent of people in the U.S. have been infected and are potentially immune; we’re not sure how long that immunity lasts, so we’ve got a long way to go to build up to that herd immunity,” Blumberg said. “Even if the vaccine was 100 percent effective, we would still need somewhere around 65 to 90 percent of the population immunized in order to consider returning to our previous way of life.”

Leaders like Trump fail if they cannot speak the truth and earn trust

During a recent Senate committee hearing on the COVID-19 crisis, Dr. Anthony Fauci told lawmakers he was concerned about “a lack of trust of authority, a lack of trust in government.”

He had reason to be worried. The Pew Center reported that July 7 only 17% of people in the U.S. have confidence in government to do the right thing. Never in the history of their surveys, which began in 1958, has that confidence been so low.

Why is trust so low and why does that matter, especially during a crisis – and especially during this crisis?

No playbook

The dilemma of leadership in modern democracy has long been the focus of my scholarship and teaching. I have asked what qualities and virtues leaders need to preside over a government of, by and for the people. If it’s a challenging topic, it is also one never lacking for material. The current era points especially to the importance of trust for effective and legitimate leadership in democracies.

The story begins with a basic principle of democracy: Leaders cannot do whatever they please.

The drafters of the United States Constitution assumed that anyone with power would always have the opportunity – and often the temptation – to abuse it. To protect society from unruly rulers, they set up an obstacle course of elaborate procedures, checks and balances, separated powers and a stringent rule of law that applied to everyone, even those who wrote the laws.

In this system, inefficiency and complexity became virtues. Deliberation trumped dispatch.

It isn’t easy for leaders to act, and it is not supposed to be.

That’s a problem during a crisis. Emergencies require swift, decisive steps, sometimes improvised and often pushing the boundaries of formal authority.

There’s no playbook, and those hurdles designed to prevent leaders from doing bad things may now prevent them from doing necessary things.

Even John Locke, the 17th-century British philosopher so influential in the American approach to accountability and limited government, understood that stuff happens. And when it does, the machinery of government may prove too slow and cumbersome.

With regret but cold realism, Locke conceded that when severe threats appear, “There is a latitude left to the executive power, to do many things of choice which the laws do not prescribe.”

Discretion granted, trust needed

That’s precisely when trust becomes critical.

The discretion granted to democratic leaders in times of crisis – the room they have to maneuver – depends entirely on how much the people trust them. And that depends on their competency, honesty and commitment to the public interest.

One of Dwight Eisenhower’s biographers explains that discipline was central to his leadership style. Eisenhower leaned heavily on experts and had the patience and persistence to navigate the complex machinery of government. Sometimes that made him appear cautious, but few questioned his competence.

Today German Chancellor Angela Merkel embodies the same set of skills, a cool, measured and rational approach that inspires confidence. High among her leadership qualities is a projection of competence, no doubt enhanced by Germany’s success responding to the pandemic.

The Financial Times political columnist Gideon Rachman wonders if the pandemic will ultimately be a setback for populist leaders such as Boris Johnson in Great Britain, Jair Bolsonaro in Brazil and Donald Trump in the United States. They seem thrilled by the theater of politics but bored by the details of governing. As their countries suffer some of the worst effects of the pandemic, Rachman believes citizens will rediscover the value of sheer competence.

Honesty and the public interest

Telling the truth also earns trust.

But honesty is more than just conveying basic facts. It is the capacity to explain the crisis, the sacrifice required and the path to a solution.

Roosevelt during the Depression, Churchill during World War II, Kennedy during the Cuban Missile Crisis and Bush in the aftermath of 9/11 (at least the immediate aftermath) were granted considerable discretion because they accurately described and credibly interpreted the challenge facing the people.

In the current crisis, medical professionals have told the inconvenient truths about the pandemic. Political leaders at the national level have offered false hopes and misleading information. That is why trust in medical professionals in the United States far exceeds trust in elected officials.

Finally, trust is given when leaders act in the public interest, not their own self-interest.

Perhaps the most damning indictment in John Bolton’s book about his time in the Trump administration was this assessment of the president: “I am hard-pressed to identify a significant Trump decision during my tenure that wasn’t driven by reelection calculations.”

One 2016 Trump voter explained his recent change of heart even more bluntly: “It was like this dude is just in it for himself. I thought he was supposed to be for the people.”

If that perception becomes widespread, it will deplete whatever stock of trust citizens have left for the president. Those Pew measures of trust are fundamental expressions of whether citizens believe leaders will forsake their own immediate interests to serve a public interest.

Dr. Fauci is right. A solution to the pandemic requires testing, contact tracing, masks, social distancing and ultimately a vaccine. It also requires leaders who are competent, honest and committed to the public interest – leaders who are trustworthy.

The absence of trust jeopardizes an effective response to a health crisis. But it also creates a political crisis, a loss of faith in democracy as a way to govern ourselves. Public health in the U.S. is at stake. So is the health of democracy.

Kenneth P. Ruscio, Senior Distinguished Lecturer, Jepson School of Leadership Studies, University of Richmond

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why the walls are starting to close in on Trump

Although the opinion section of the Washington Post has its share of liberals and progressives, it has also been a consistent source of right-wing Never Trump commentary that ranges from columnists Jennifer Rubin, Max Boot and Kathleen Parker to guest op-eds by attorney George Conway. This week, two of those conservatives cite recent examples of the walls closing in on President Donald Trump: Conway discusses the U.S. Supreme Court’s ruling in Trump v. Vance and the arrival of Mary Trump’s tell-all book, while Rubin asserts that former Vice President Joe Biden is seizing the populist narrative from Trump.

In his op-ed, Conway writes: “What do a gripping family tell-all book and a momentous Supreme Court decision have in common? Quite a lot, it turns out. The book, to be published next week, comes from Mary L. Trump, a clinical psychologist who happens also to be niece of Donald Trump, the president of the United States. It describes how Donald Trump has been protected by institutions his entire life. Trump v. Vance, the Supreme Court case decided Thursday, illustrates how the president has pushed those protections to the limit — and how they’re about to end.”

The U.S. Supreme Court, in its 7-2 decision in Trump v. Vance, ruled that “executive privilege” does not shield Trump from a request by the office of Manhattan District Attorney Cyrus Vance — which has been seeking the president’s financial records. Vance, according to the high court, is within his right to pursue those documents as part of a Trump investigation regardless of the fact that he is president of the United States.

Conway writes that Mary Trump’s book, “Too Much and Never Enough: How My Family Created the World’s Most Dangerous Man,” tells “a remarkable story, the broad strokes of which many already knew. Mary Trump offers a tale of what she calls ‘malignant’ family dysfunction, and how it produced a malignantly dysfunctional president. It’s an unsparing and relentlessly detailed account.”

The attorney adds that Mary Trump alleges that “Donald Trump paid someone to take the SAT for him. He also tried to trick his mentally declining father into signing a codicil that would have stripped his siblings of their inheritances. … Mary Trump’s point is that her uncle has spent his life being protected from the consequences of his actions and shortcomings.”

Meanwhile, Rubin, in her column, argues that Biden “snatched the populist mantle back from Trump” on Thursday, when he unveiled a proposal for spending $700 billion on U.S. products and research.”

According to Rubin: “Biden’s plan is aimed squarely at workers based on a message of ‘fairness.’ As he explained on Thursday during a speech in Dunmore, Pennsylvania, the presumptive Democratic nominee seeks ‘an economy where every American enjoys a fair return for their work — and an equal chance to get ahead. An economy that is more powerful precisely because everyone is cut in on the deal. An economy that says investing in the American people and working families is more important than the nearly $2 trillion dollar tax break Trump predominantly handed out to the richest Americans.'”

Biden’s “Build Back Better” plan, Rubin notes, calls for a made-in-the-U.S.A. program — which is very much the type of thing Trump has campaigned on.

Rubin wraps up her column by contending that Biden’s economic plan strikes a left/center balance and can appeal to both liberals and centrists.

“Biden, whose staff consulted with Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.), managed, apparently, to satisfy the left wing of his party without putting forth something that will scare the rest of the electorate,” Rubin writes. “Generally, this is how every winning Democratic candidate since World War II has campaigned. It has been good politics to run on an active federal government working for the little guy — especially when your opponent has been rewarding the super-rich and corporations.”

The long, ignoble history of presidents snubbing medical advice

President Donald Trump did something very unexpected on Thursday: Speaking with Fox News’ Sean Hannity in a live phone interview, he said that he would most likely wear a mask while visiting Walter Reed medical center over the weekend, adding that “it’s fine to wear a mask if it makes you feel comfortable.”

His claim was surprising inasmuch as the president has been reluctant to wear a mask publicly prior to now. Indeed, Trump’s anti-mask behavior bucks the advice of public health experts, who agree that people should wear masks whenever they are in environments where they or others could be exposed to the coronavirus, not simply when they feel comfortable. Indeed, not only has Trump avoided wearing a mask until now, but he actively mocked his Democratic opponent in the upcoming election, former Vice President Joe Biden, for being responsible and doing so.

On the one hand, Trump is following a sad tradition of American presidents either taking risks with their health or covering up serious medical issues in order to seem tough. The key difference between Trump and his predecessors, however, is that they never did so in ways that directly endangered the health of the people around them or deliberately encouraged reckless behavior.

The most obvious instance of a president bucking medical wisdom resulted in that president’s untimely death. When 68-year-old William Henry Harrison refused to wear either a coat or a hat while delivering his nearly two hour-long inaugural address (the longest in history) during wet and freezing weather, he contracted what his doctor described as “pneumonia of the lower lobe of the right lung, complicated by congestion of the liver.” Harrison eventually died, after having served as president for only one month, making him both the shortest-served president and a cautionary tale about the dangers of not listening to your doctors.

(For what it’s worth, some modern epidemiologists argue that Harrison actually died of unrelated ailments that sprung from the disease-infested marshes near the White House. Even if that is true, though, his decision to not wear a coat or hat during bad weather remains undeniably unwise.)

Yet Harrison, for all of his hubris, did not put others at risk through his behavior. A similar observation can be made about presidents who infamously concealed major health maladies: Grover Cleveland covering up an oral tumor and instead undergoing a secret operation; Woodrow Wilson suffering a debilitating stroke and yet staying in power for the last year-and-a-half of his presidency; Franklin Roosevelt refusing to disclose that he was likely to suffer a stroke as he sought reelection in 1944 (he died a few months into the term he won that year); John F. Kennedy masking the chronic pain of Addison’s disease, colitis and severe back problems with methamphetamines. There are even rumors that Ronald Reagan began to succumb to Alzheimer’s while he was still in office and covered it up.

None of these actions, to be clear, were ethical. Each one deprived the American people of knowledge to which they were entitled about their leaders during major crises, like the 1890s economic depression, the Great Depression, the influenza pandemic, the aftermath of World War I, the closing months of World War II, the civil rights movement and the Cold War.

“All of those situations indicate dubious ethics, but [did not] endanger other people,” Allan Lichtman, a political scientist at American University, told Salon. “When Grover Cleveland goes offshore to have an operation for his cancer, he’s not endangering anyone else. FDR is not dangerous. His health ailments were not contagious, and neither were Wilson’s or Kennedy’s as far as we know. Like Trump, they were preserving their manly image. But unlike Trump, they were not endangering the people around them or endangering the American people in their own way.”

Regarding the latter observation, Lichtman stressed that one of a president’s responsibilities is to lead by example, and Trump is failing to do that when he refuses to wear a mask and acts like choosing to put one on should be optional.

“It’s a horrible message,” Lichtman explained. “It shows he doesn’t care about the health of his constituents. He cares more about his own image than he does about keeping the people around him safe.” Lichtman also pointed out that “there is nothing unmasculine about wearing a mask. It is not a show of weakness to wear a mask anymore than it is a show of weakness not to drive drunk.”

Salon also reached out to medical experts about the importance of wearing masks. They made it clear that there is no rational disagreement on this point: To protect yourself and those around you, you should wear one.

“Masks are important for catching droplets and microdroplet aerosols expelled while talking and breathing (not just sneezing or coughing), which was just recognized by WHO and 239 scientists,” Dr. Eric Feigl-Ding, Senior Fellow at the Federation of American Scientists, told Salon by email. “Trump would be potentially at risk, if not for the daily immediate on the spot testing of everyone who approaches him in his surroundings. Anyone who tests positive is isolated and prevented from seeing him (already happened to a general who was about to visit him). Another reason that TESTING saves lives too, in addition to masks.”

Dr. Russell Medford, Chairman of the Center for Global Health Innovation and Global Health Crisis Coordination Center, made a similar point.

“Up to 40 percent of people infected with COVID-19 may have no symptoms, but by the simple act of talking have the potential of infecting others by expelling virus-containing droplets into the air,” Medford told Salon by email. “Multiple scientific studies demonstrate that masks can capture many of these droplets and thus reduce the concentration of virus expelled into the air.”

He added, “A recent analysis by the Institute for Health Metrics and Evaluation [IHME] at the University of Washington estimates that widespread use of mask could contribute to a reduction of  COVID-19 respiratory infections by up to 33%.  Furthermore, if 95% of the US population always wore masks in public, IHME models project that more than half the over 60,000 deaths that are predicted between now and October 1 would be avoided.”

Trump’s actions prior to and since the outbreak of the coronavirus pandemic have cost thousands of lives and plunged America into the worst economic crisis since the 2008 recession. In addition to disbanding the global health national security team in 2018 and calling for budget cuts to the Centers for Disease Control, he also denied that a crisis existed for more than two months after the coronavirus reached the United States and has peddled pseudoscientific cures to the general public. Indeed, the image of him refusing a mask is perhaps a fitting symbol for his approach to the pandemic.

The plan meant to unite Biden and Bernie voters on climate is finally here

Once upon a time, many moons ago — i.e., back in April — Democratic presidential primary candidate Bernie Sanders agreed to exit the race and join forces with his mortal frenemy Joe Biden to help the former vice president take the White House. The two announced they were putting together a series of joint “unity” task forces with experts from each of their camps to shape the Democratic platform, including a task force on climate change.

After a few months of weekly Zoom meetings and conference calls, the task forces sent their final recommendations to the Democratic National Committee for its consideration on Wednesday.

On climate change, the two candidates and their supporters had some serious divides to bridge. Over the course of nine months of primary debates, Biden touted his plan to build 500,000 electric vehicle chargers and put his faith in American exceptionalism while Sanders bashed fossil fuel executives and promoted the Green New Deal. To try to find a middle ground, Sanders appointed Representative Alexandria Ocasio-Cortez, Sunrise Movement co-founder Varshini Prakash, and Catherine Flowers, the founder of the Center for Rural Enterprise and Environmental Justice, to the joint climate task force. Biden selected former Secretary of State John Kerry, former Environmental Protection Agency administrator Gina McCarthy, and former Biden policy advisor Kerry Duggan, along with two members of Congress.

From the preamble to the task force’s policy recommendations, it’s clear that Sanders’ camp had a meaningful influence on the platform. Titled “Combating the climate crisis and pursuing environmental justice,” the introduction immediately namechecks communities that have suffered the most from the effects of climate change, like Houston, Texas and Paradise, California, and quickly moves on to those that have long suffered from racist policies and pollution, like Flint, Michigan and the Navajo Nation. The platform goes on to work justice and equity into pretty much every bullet point, from eliminating legacy pollution like Superfund sites, to creating union jobs in clean energy that reflect the full diversity of the country. While the Green New Deal is never mentioned, traces of it are all over the place.

Prakash wrote about her experience on the task force on Twitter on Wednesday, explaining that she had two goals: to push Biden to increase his ambition on climate change in terms of timelines and benchmarks, and to place environmental and climate justice at the heart of all of Biden’s climate policies.

On Prakash’s first goal, there was certainly some success. Previously, Biden’s climate policies centered around achieving 100 percent clean electricity by 2050. The task force shaved 15 years off that goal. It also came up with a slew of closer, more specific benchmarks: Within five years, make all school buses electric and help spur retrofits of 4 million buildings by unlocking private sector funding and setting efficiency standards, and by 2030, zero out the carbon footprint of all new buildings.

As for Prakash’s second goal, she applauded Biden’s commitment to putting environmental justice at the heart of his climate policy agenda by “directing federal funds to disadvantaged communities, ending pollution & toxic waste sites, and creating mitigation strategies and rebuilding from disaster in just and equitable ways.”

“We are leaving these discussions with policies that, if implemented, will make Joe Biden’s climate agenda far more powerful, equitable, and urgent than where his plans were just weeks ago,” she tweeted.

Naturally, there is evidence of compromise throughout the task force’s plan. While the document endorses repealing fossil fuel subsidies and addressing methane emissions from oil and gas infrastructure, it does not say anything about fracking, and the only pipeline that it mentions is the “diverse pipeline of talent” the government should help create to fill good clean energy jobs. However, it does urge the Democratic party to explicitly fess up to “historic wrongs” perpetrated against Native American tribes with respect to infrastructure (i.e. pipelines), and to commit to a more robust and meaningful consultation process with tribes across all federal agencies. To do so, the task force recommends conducting a “Tribal Needs Assessment” to understand how to support more than 500 tribes in the energy transition.

Primary season left the Democratic party deeply divided, and some on the climate left will inevitably remain skeptical that a Biden administration will be ambitious enough. This document is by no means the scripture of climate policy. But Biden has proven to be pliant, allowing himself to be pushed further and further on climate since first announcing his candidacy, and this experiment in intra-party negotiation and compromise offers some evidence that the trend could continue.

A road trip through the red states, while the pandemic spikes

So we found ourselves on the road during the pandemic. We knew it would almost certainly prove a bad move.

My wife and I were more than a little concerned. We are both getting “on in years,” as they say, and I have a medical condition that puts me at greater risk. In the back seat of the car, we had provisions for the road so we would not have to stop until we reached the hotel we had Pricelined in downtown Knoxville, Tennessee, along with a basket of cleaning supplies we hoped would keep us safe: a roll of shop towels (a pandemic discovery for which I plan to live longer—paper towels on steroids that you can rinse out and use again and again), a bottle of disinfecting bleach, various other sprays and wipes we had been using at home. 

We had determined to hit the road to help out our older daughter and her husband. They were lucky to have accommodating employers, but they had been struggling to work from home with a toddler, our first grandchild. Now our daughter’s husband was being called back to be in the office a couple times a week, and their child care center was only now beginning to look at what it might mean to reopen.

Was this even a reasonably considered idea? After an exponentially chaotic response to the pandemic by the Trump administration — from repeatedly downplaying the threat in the first months; to putting Mike Pence, a man not of science but of relentless displays of faith, who had failed to act quickly during a public health crisis in Indiana during his governorship, nominally in charge; to the president himself looming next to, and talking over, health experts at his increasingly bizarre daily briefings; to pitting states against each other for urgently needed medical supplies; to politicizing the wearing of masks; to muzzling their own health experts; to, most recently, seemingly giving up on the whole thing and just wishing it away — the wacko conspiracy theory going by the name “The Plandemic” was an attempt to obscure the catastrophically real “No Plan-demic.”

If we lived in Europe or in Asia, we could now reasonably make this trip. Now the EU countries were closed to us, in another measure of Trumpian American exceptionalism.

Naturally, the virus had now come a-courtin’ to the South and the West, where it was fixin’ to set a spell (OK, sorry, I’ll stop that). Unlike many human beings, a virus does not discriminate; any human host will do nicely — whether he or she be called libtard or freedumb fighter.

In the face of this trend in the United States — 2.7 million infected, 135,000 dead (with 175,000 or more projected by October), 25% of the global deaths with only 4% of the population — we headed out of St. Louis toward other states that were now literally red on the pandemic maps. Various governors were variously attempting to both close their eyes to the threat and on-the-fly set some “on-your-honor” rules for reopening their economies.

Despite the messaging from the White House, the country had, for a while, done the right thing to flatten the curve. But Trump, Republican members of Congress and Republican governors had relentlessly pushed back in April for early reopening of the economy. If you are a member of a party that has fought since the days of Ronald Reagan to discredit the working of government, that does not believe in science or expertise of any kind, that is not willing to acknowledge even a reasonably objective view of reality, then pushing to reopen against all available evidence is a pretty simple thing to do.

We were traveling on the last weekend of June, when an already overloaded news cycle, following the president’s lead, became nearly deranged. The New York Times had just reported that Trump and Pence had been briefed back in March that the Russians had offered bounties to the Taliban for the deaths of U.S. service members. Then Trump retweeted a retirement center resident in Florida shouting, “White power!”

A few months earlier, we had made the 11-hour trip to and from Charlotte during the testimony in the House impeachment proceedings, and what we were hearing from the radio at the tail end of June 2020 was perhaps even more surreal.

Friends and colleagues from Britain and the Netherlands had been aghast at the images of partiers in the Ozarks some weeks before. They were highly attuned to the Ozarks because of the Netflix series (which is actually filmed near Atlanta, in another red state getting redder on the COVID-19 maps). Of course, we’ve had the chance to feel a similar horror watching the opening of bars and beaches in the U.K., and Belgium and the Netherlands took quite some time to tamp down the rise in infections.

We had already seen numerous videos of unmasked people angrily confronting house rules — arguing in restaurants and grocery stores — and the poor employees who somehow had to deal with these toddler-level meltdowns by people who appeared, at least visually, to be fully grown adults. We steeled ourselves to hear something about it when we wore our masks.

A Paul Simon song from an album I had back in the 1980s was persistently on my mind.

Slip-slidin’ away,
Slip-slidin’ away,
You know the nearer your destination
The more you’re slip slidin’ away.

The sacrifices many of the American public made to tamp down the curve in March and April were being wasted by this urgent reopening. And the shared sense of caring for our neighbors, our fellow citizens, by wearing masks in public is nothing to sneeze at. But sneeze they do, and cough and, on occasion, even spit.

In taking this trip, we were following other family members who worked to bridge the gap to the reopening of the childcare center. But didn’t that make it more risky to make the visit? Sure it did.

Still, we imagined, as the pandemic spiked in the southern and western United States, that governors would restate the rules and give the lead to their public health officials. Surely, at this point, they would. Wearing masks would become required. 

We all engage in magical thinking from time to time. You just don’t want to see it in statements by your public leaders.

In any case, we determined to make the trip and do our best to remain safe by wearing a mask whenever we were in public.

Various memes resonated for us, from the earnest (I wear a mask not to protect myself, but to protect you), to the true-but-unlikely-to-woo (A mask is not a political statement. It is an IQ test), to the How-Are-You-Not-Getting-This? (If I’m naked and I pee on you, you get pee on you. But if I’m wearing pants and pee on you…).

But mask wearing (or not) had become another culture-war distraction pushed by radio and television personalities like Rush Limbaugh, Tucker Carlson and Laura Ingraham. 

The mask is largely supposed to protect others, but when others don’t wear a mask or halfheartedly wear a mask (with, say, their noses exposed) it is natural to want, defensively, to have more protection for yourself. I started wearing a mask that my wife sewed in the early weeks of the lockdown (with a place to tuck in a filter) underneath my face gaiter. As I would leave a grocery store, once I was safely away from others I would peel down the gaiter and then the homemade mask. I imagined there being yet another mask beneath that one, at some point, like a bleak pandemic version of the hilarious “Pin-up Special” sendup of old-timey stripper movies that Alison Brie and Gillian Jacobs did for GQ in 2011. My version would, of course, not be titillating — but I hope it would be nearly as effective in reducing my exposure.

As some readers of Salon might remember, I had been reading the “Federalist Papers” during the pandemic — and I still have a long way to go. I’m trying to figure out how these articles in favor of a strong federal government became the darlings of the conservative right. In any case, this passage, by Alexander Hamilton, resonates in the face of, well, unmasked faces: 

Why has government been instituted at all? Because the passions of men will not conform to the dictates of reason and justice, without constraints. Has it been found that bodies of men act with more rectitude or greater disinterestedness than individuals? The contrary of this has been inferred by all accurate observers of the conduct of mankind; and the inference is founded upon obvious reasons. Regard to reputation has a less active influence, when the infamy of a bad action is to be divided among a number than when it is to fall singly upon one. A spirit of faction, which is apt to mingle its poison in the deliberations of all bodies of men, will often hurry the persons of whom they are composed into improprieties and excesses, for which they would blush in a private capacity. 

Power in numbers, then, whether we are doing good or ill. And it is something Trump has capitalized on; encouraging his followers with truly deplorable views (yeah, we knew she was right; back then it just seemed like a mistake to say it out loud) to crawl out from under whatever stones they had been under into the bright artificial light of a rally in some city in a red state and scream about their freedom to wantonly misbehave.

And then there was the Obama administration’s pandemic playbook that the incoming Trump administration tossed aside, with nary a glance. And then, for good measure, tossed aside the pandemic response team itself, possibly worried they might bring up that damn playbook again.

Senate Majority Leader Mitch McConnell insisted there had never been a pandemic playbook, until he was later forced to admit that, yes, there was. One day this effort to lie and dissemble (and many others of the era) should be written up and published in the Journal of Endless Gaslighting.

Politico published the playbook back in March, and I spent an hour or so reading through it the other day. Gosh, it is a real thing, just as one might imagine. And within it are rubrics for decision-making and examples from other real-life pandemics.

So here we were, pulling into Knoxville, Tennessee, armed with our masks and cleaning supplies, but unarmed in terms of national or state-level leadership.

At the hotel (a Marriott, but does it really matter?), we donned our masks and rolled our bags in — only to find nearly all the guests blithely walking through the lobby mask-less and in groups. As with most establishments at home, there was a plea to wear a mask posted on the door and some general advice by the elevators, but little or no enforcement.

White fragility clamps the lid on any discussion of the state of race relations in this country, but class fragility does the same with any discussion of moderating the yee-haw capitalism practiced in this country. So how can one really expect hourly employees to do the enforcement?

After giving our hotel room a good cleaning, we attempted to walk a bit around downtown Knoxville but were eventually thwarted. There were just too many people out and about, only about a quarter of them wearing masks.

In Charlotte, we mostly hid out with the family. I made a few forays to the nearby Harris-Teeter to pick up some things, but it was crowded and, not really knowing the store, I found myself circling back too much. Every customer I saw was wearing a mask, though a few employees were breathing freely with their noses.

Again, I was conscious of how lucky we all were: lucky to have jobs that could be done remotely and to have employers who understood the gravity of the situation and planned accordingly and humanely. We were able to make the trip because I had vacation time to take. But what about parents without such family resources, or parents with multiple children, or single parents? 

In my most fearful moments, when I would think of putting on multiple masks in some sort of useless gesture of self-defense (masks, of course, mostly protect the people you encounter), I would think that my wife and I were being unwillingly pulled into the fevered Darwinian plan, put forward by Trump and other Republicans, that we sacrifice ourselves for the economy. We were risking ourselves, yes, but for the family — and we would never have been put into this position except for cascading failures in the U.S. response to the pandemic, which are ongoing. Even now, hospitals in red states are reporting they lack personal protective equipment and are running out of ICU beds.

A couple of days later, I was standing in the Common Market in Charlotte after ordering a sandwich. A man walked in, coughed deeply and with evident satisfaction, and then, looking at me, slowly put on his mask. It was clear he was doing it just so he could order (the shop requires masks). I walked back outside. As I waited for my order, I kept my gaiter up and thought about how many people would not survive this because so many of us have refused to work together since the anti-government infections shed by Reagan and Newt Gingrich. 

In my mind, the Paul Simon song insisted itself again. I thought of my grandson, my daughters, my wife, my extended family, of the fragile beauty of the environment and of life itself:

I live in fear
My love for you’s so overpowering
I’m afraid that I will disappear

Slip-slidin’ away
Slip-slidin’ away
You know the nearer your destination
The more you’re slip-slidin’ away.

Already we are in our last few days in Charlotte. This morning, my wife and I went for an early morning run through some of the streets in Plaza Midwood, admiring the architecture of many houses. Along the Plaza, we passed an older man who was walking and wearing a mask. We turned back and exchanged good-morning greetings. I asked him how he was doing. He said, “I’m still alive. Thank God!” 

When we were out of earshot, I said, “And thanks to your decision to be sensible.”

Medicine’s misguided romance with machines is making the coronavirus worse

As Covid-19 began to lay siege to New York City’s hospitals in March, a small but consequential debate broke out in American emergency rooms and intensive care units: Was it possible that ventilators, the much-politicized medical devices widely seen as a lifeline for severely ill Covid-19 patients, were being overused? With a pandemic poised to sweep through the U.S. and the horrific example of Italy still lingering, the dispute gained a particular urgency.

At the core of the debate was a four-letter acronym that most Americans had never heard of: ARDS, or acute respiratory distress syndrome, a harrowing lung condition that was listed on many Covid-19 death certificates. Since it was first identified half a century ago, ARDS has been mired in controversy — over how to define it, how to diagnose it, and whether it should be considered a true clinical condition at all. It is because of ARDS, a diagnosis that owes its very existence to a machine, that we went into the pandemic thinking ventilators would save us. Its story serves as a cautionary tale about the dangers of prioritizing high technology and its medical paradigms in settings where one medical treatment does not fit all.

Coined in 1967 by Thomas Petty, a respiratory physician at the University of Colorado, ARDS has been a source of contention from the start. The causes of the condition were, in Petty’s own words, “obscure.” He and three colleagues proposed the syndrome after observing a dozen patients with radically different illnesses and injuries (gunshots, pancreatitis, traffic accidents) who all presented with similar respiratory symptoms: low blood oxygen levels; fluid or other infiltrates in the lungs; and “stiff” lungs that didn’t properly expand and contract even under mechanical ventilation.

Desperate for a solution, Petty and his colleagues put the patients on an older ventilator that blew at high pressure, even as a patient exhaled — a technique he called positive end-expiratory pressure, or PEEP. The patients’ blood oxygen levels improved, and Petty and his colleagues felt confident that they had identified a new clinical syndrome, along with an effective treatment for it. They dispatched a paper to The New England Journal of Medicine — which promptly rejected it, on the grounds that the doctors’ use of ventilators was unorthodox and possibly dangerous, Petty reported. The paper was rejected by two other journals before being published by The Lancet in 1967. It remains the foundational paper on ARDS and has been cited more than 4,000 times.

Although Petty’s patients shared a number of common symptoms, he insisted that the patients’ positive response to PEEP was one of the condition’s unifying traits. The ventilator, even more so than the underlying disease or injury, was crucial to the definition of the syndrome.

More than a few doctors and scientists were suspicious of the new syndrome. In a 1975 editorial, “The Adult Respiratory Distress Syndrome, (May it Rest in Peace),” Petty’s main antagonist, pulmonologist John Murray, called ARDS a “fashionable” disorder, a haphazard “lumping” together of unrelated chest conditions, which seemed only to share a final set of symptoms. In his response, “Confessions of a ‘Lumper,'” Petty argued that even if you conceded Murray’s point the cause of the disorder was irrelevant; the pathology was what mattered. If a disease, injury, or illness resulted in poor oxygenation, lung infiltrates, and stiff lungs, then it had to be ARDS, he wrote. Those advocating for a more nuanced diagnosis he labelled “separatists.”

Over the ensuing decades, even those doctors who accepted ARDS as a valid clinical condition would frequently disagree over how it should be diagnosed. In 1994, a major redefinition removed the criteria to measure the ability of the lungs to expand and contract in response to changes in pressure known as lung compliance in an attempt to standardize the disorder. In 2012, a panel of experts again redefined the syndrome, specifying that, to make a proper diagnosis, blood-oxygen levels must be measured while a patient is on PEEP. That year, an editorial in the Journal of the American Medical Association noted warily that the latest definition “has essentially excluded ARDS as a possible diagnosis in patients without ventilation.” The diagnosis of ARDS had become tied to the ventilator.

So this year, when Covid-19 patients began to arrive at hospitals with frighteningly low blood-oxygen levels, matching preliminary reports from China, they were funneled in droves onto ventilators.

But a 75-year-old Italian anesthesiologist and intensive care specialist, Luciano Gattinoni, along with a group of colleagues, cried foul. He noticed that Covid-19 pneumonia differed from “typical” ARDS in one important way: His patients’ blood oxygen levels were low, but many of them had no difficulty breathing on their own; their lungs were relatively compliant. That condition would come to be known as “silent,” or “happy” hypoxemia. Yet under the updated protocols, patients were being diagnosed with ARDS and quickly put on a ventilator, a harrowingly invasive procedure that involves inserting a tube down the patient’s throat and putting them under sedation to keep it there. Ventilators saved lives, physicians say, but they can also have considerable side effects, including lung damage.

“Why do you use this kind of PEEP? Are you crazy?” Gattinoni remembers counseling his younger colleagues at his hospital.

Gattinoni warned them against viewing ventilators as cure-alls and urged them to, whenever possible, supply patients with “the lowest possible PEEP and gentle ventilation,” as he later put it in a letter published in the American Journal of Respiratory and Critical Care Medicine. For early-stage patients, he advised non-invasive methods in the hopes of avoiding ventilation altogether. Other ICU and ER doctors related that gentler methods such as using nasal cannulas and face masks to deliver air to the lungs seemed to improve oxygen levels, STAT reported.

Gattinoni’s recommendations touched off considerable controversy over whether or not Covid-19 causes ARDS, whether ventilators offer the best treatment for the new disease, and how the machines should be operated. That debate is ongoing, and has split, roughly, into two camps: One side argues that conventional protocols should be followed until “a detailed characterization of Covid-19 respiratory failure and its response to established ARDS therapies” can be made; the other asserts that “mistakes” were made in the early days of the pandemic and the standard treatment “should be deeply reconsidered,” as Gattinoni argued in a recent rebuttal.

At the height of New York’s pandemic in late March, an emergency room doctor at Maimonides Medical Center in Brooklyn named Cameron Kyle-Sidell posted a video on YouTube decrying the risks of relying on “a medical paradigm that is untrue.” Kyle-Sidell’s cri de coeur, which has drawn more than 800,000 views to date, now looks prescient: One study in New York City found that 88 percent of Covid-19 patients placed on ventilators died.

“What was happening at the bedside was so stark that it’s always been hard for me to accept the possibility that somehow we weren’t causing a significant amount of morbidity with our initial practice,” said Kyle-Sidell in a recent interview.

There is, perhaps, a moral to the story. While much of the discussion around ventilators in the early days of the Covid-19 crisis centered around their limited supply, it took time before their limited effectiveness was revealed. Doctors like Helen Ouyang, an emergency physician in New York City, reported feeling devastated by the limits of modern medicine, citing a concept most associated with combat veterans known as moral injury to describe the psychological impact on doctors as technology was failing their patients.

Robert Kacmarek, director of respiratory care at Massachusetts General Hospital, also recalled “difficult” times as Covid-19 exposed the limits of standardized protocols. “For this kind of disease especially, you have to have individualized medicine,” he said. “You have to set the ventilator based on the individual pathophysiology of the patient and not based on a protocol that is designed for multitudes.”

Here, earlier uses of mechanical ventilation offer a valuable lesson. In the summer of 1952, when a severe polio epidemic struck the city of Copenhagen, local medical students worked for weeks in eight-hour shifts, squeezing rubber bags to hand ventilate over 300 polio patients. The students adjusted their technique within a human context, based on clues gleaned from eye contact with their patients; the technology itself was secondary. The effects were profound. The mortality rate dropped by about half, and the episode established the value of ventilation in a way that changed the course of medicine.

By contrast, the ARDS controversy that shaded the early response to the Covid-19 pandemic exposed a disconnect between the promise of high technology and the bedside reality. The vigorous debate on the value of a half-century old diagnosis is a reminder that in medicine, no machine or protocol, however well-designed, can substitute for empathy, judgment, and evidence.

* * *

Yvan Prkachin is a historian of medicine and medical technologies, and a lecturer in the history of science at Harvard University.

Lisa De Bode is a freelance journalist and a 2019 MIT Knight Science Journalism Fellow.

This article was originally published on Undark. Read the original article.

A bad day for Trump is a good day for the country

If you were hoping to see Donald Trump’s financial records before the 2020 election, today was not your day. If you were hoping to go to bed tonight in a nation with a president and not a sovereign, sleep tight, because you won.

In two Supreme Court decisions freighted with the potential for generational impact — Trump v. Vance and Trump v. Mazars — a 7-2 majority remanded both cases back to the lower courts for further review while delivering a slashing rebuke to a president who would put himself outside the scope of oversight and the constitutional separation of powers.

Specifically in Vance, the court resoundingly affirmed that the president of the United States is not above the law. “Two hundred years ago, a great jurist of our Court established that no citizen, not even the President, is categorically above the common duty to produce evidence when called upon in a criminal proceeding,” Chief Justice John Roberts wrote for the majority. “We reaffirm that principle today and hold that the President is neither absolutely immune from state criminal subpoenas seeking his private papers nor entitled to a heightened standard of need.”

The Vance ruling concluded by returning the case to the lower courts, because after having settled the issue of absolute immunity, the majority held that Trump still has the right to redress the other proffered arguments. “The arguments presented here and in the Court of Appeals were limited to absolute immunity and heightened need,” wrote Roberts. “The Court of Appeals, however, has directed that the case be returned to the District Court, where the President may raise further arguments as appropriate.”

New York Attorney General Cyrus Vance Jr. stands a very strong chance of prevailing in the upcoming lower court arguments for his case. “This is a tremendous victory for our nation’s system of justice and its founding principle that no one — not even a president — is above the law,” saidVance in a statement. “Our investigation, which was delayed for almost a year by this lawsuit, will resume, guided as always by the grand jury’s solemn obligation to follow the law and the facts, wherever they may lead.”

The Mazars ruling was another disappointing decision for those seeking to make Trump’s financial records public before the presidential election. Certainly, Democratic House members were hoping for a different outcome. That being said, the Mazars ruling was not a death blow to the efforts toward obtaining those documents — the Supreme Court justices punted it back to the lower courts because, they argued, the serious issues of separation of powers deserve more scrutiny before an ultimate ruling.

“Congressional subpoenas for information from the President, however, implicate special concerns regarding the separation of powers,” reads the majority decision. “The courts below did not take adequate account of those concerns. The judgments of the Courts of Appeals for the D. C. Circuit and the Second Circuit are vacated, and the cases are remanded for further proceedings consistent with this opinion.”

More importantly, however, the justices could have ruled that the president does not have to heed congressional subpoenas or endure congressional oversight. The court did not do so, and that terrible possibility did not come to pass. Between Vance and Mazars, the court was clear: The separation of powers stands, and Donald Trump is not a king.

Attorney General Vance has been seeking financial documents from the Trump Organization to determine if that organization falsified business records to cover up hush money to two women whom Trump reportedly had affairs with. Congress wanted Trump’s tax records because providing tax records is what presidents have done for decades, and House investigators want to know who may be pulling Trump’s financial strings, perhaps in ways that damage national security.

Vance won, while Congress has suffered a setback but remains in the fight if it chooses to pursue it. As the tax documents will not be provided to House committees before the election per the Mazars ruling, it remains to be seen if they will maintain this effort absent its hoped-for political impact. House Speaker Pelosi certainly sounded like the issue is not settled. “We have a path that the Supreme Court has laid out that we will certainly not ignore,” she said on Thursday, “and we will never stop our oversight.”

Trump allies fanned out saying this is a great day for the White House. You wouldn’t know it from Trump’s Twitter feed. The president, for lack of a better description, is volcanically pissed.

We have a totally corrupt previous Administration, including a President and Vice President who spied on my campaign, AND GOT CAUGHT…and nothing happens to them. This crime was taking place even before my election, everyone knows it, and yet all are frozen stiff with fear….

— Donald J. Trump (@realDonaldTrump) July 9, 2020

Courts in the past have given “broad deference”. BUT NOT ME!

— Donald J. Trump (@realDonaldTrump) July 9, 2020

The Supreme Court sends case back to Lower Court, arguments to continue. This is all a political prosecution. I won the Mueller Witch Hunt, and others, and now I have to keep fighting in a politically corrupt New York. Not fair to this Presidency or Administration!

— Donald J. Trump (@realDonaldTrump) July 9, 2020

Adding insult to injury, Justices Neil Gorsuch and Brett Kavanaugh — each Trump appointees he fought hard for — sided with Roberts and the majority in both cases. That has to burn.

This day could have been much worse for Trump, who has fought like a cornered wolverine for years to keep these tax documents secret. The massive review of Trump’s older family financial records released by The New York Times in 2018 tell a fair portion of the utterly corrupt tale, but more recent data has remained beyond the public’s reach, and remains so today.

The fact that his records will in all likelihood fall into the hands of a New York grand jury is not welcome news for Trump. However, he avoided the fate of Richard Nixon, who lost unanimously before the high court in trying to keep the Watergate tapes secret, and was soon forced to resign.

Conversely, this day could have been utterly calamitous for the nation and its constitutional framework. Had the high court accepted Trump’s broad claims of immunity in either Vance or Mazars, the office of the president would have been placed forever above the reach of law or oversight, and the republic itself would have crumbled before dinner.

Put this day at court in the bank and call it a win, though not a complete one. Still, anything that infuriates Trump like this has to be a good thing.

Copyright © Truthout. Reprinted with permission.

Police, prisons, and the Pentagon

Think of it as a war system that’s been coming home for years. The murder of George Floyd has finally shone a spotlight on the need to defund local police departments and find alternatives that provide more genuine safety and security. The same sort of spotlight needs soon to be shone on the American military machine and the wildly well-funded damage it’s been doing for almost 19 years across the Greater Middle East and Africa.

Distorted funding priorities aren’t the only driving force behind police violence against communities of color, but shifting such resources away from policing and to areas like jobs, education, housing, and restorative justice could be an important part of the solution. And any effort to boost spending on social programs should include massive cuts to the Pentagon’s bloated budget. In short, it’s time to defund our wars, both at home and abroad. 

The high cost of police and prisons

In most states and localities, spending on police and prisons outweighs what the Reverend Martin Luther King, Jr., once described as “programs of social uplift.” The numbers are staggering. In some jurisdictions, police alone can account for up to 40% of local budgets, leaving little room for other priorities. In New York City, for instance, funding the police department’s operations and compensation costs more than $10 billion yearly — more, that is, than the federal government spends on the Centers for Disease Control and Prevention. Nationwide, more than $100 billion annually goes into policing.

Now, add to that another figure: what it costs to hold roughly two million (yes 2,000,000!) Americans in prisons and jails — roughly $120 billion a year. Like policing, in other words, incarceration is big business in this country in 2020. After all, prison populations have grown by nearly 700% since 1972, driven in significant part by the “war on drugs,” a so-called war that has disproportionately targeted people of color.

The elephant in the room: Pentagon spending

In addition to the police and prisons, the other major source of American militarized spending is, of course, the Pentagon. That department, along with related activities like nuclear weapons funding at the Department of Energy, now gobbles up at least $750 billion per year. That’s more than the military budgets of the next 10 countries combined.

Just as prisons and policing consume a startling proportion of state and local budgets, the Pentagon accounts for more than half of the federal government’s discretionary budget and that includes most government functions other than Social Security, Medicare, and Medicaid. As Ashik Siddique of the National Priorities Project has noted, the Trump administration’s latest budget proposal “prioritizes brute force and militarization over diplomatic and humanitarian solutions to pressing societal crises” in a particularly striking way. “Just about every non-militarized department funded by the discretionary budget,” he adds, “is on the chopping block, including all those that focus on reducing poverty and meeting human needs like education, housing, labor, health, energy, and transportation.”

Spending on the militarization of the U.S.-Mexico border and the deportation of immigrants through agencies like ICE (Immigration and Customs Enforcement) and Customs and Border Protection totals another $24 billionannually. That puts U.S. spending on police, prisons, and the Pentagon at nearly $1 trillion per year and that doesn’t even include the soaring budgets of other parts of the American national security state like the Department of Homeland Security ($92 billion) and the Veterans Administration ($243 billion — a cost of past wars). Back in May 2019, Mandy Smithberger of the Project on Government Oversight and I had already estimated that the full national security budget, including the Pentagon, was approximately $1.25 trillion a year and that estimate, of course, didn’t even include the police and the prison system!

Another way of looking at the problem is to focus on just how much of the federal budget goes to the Pentagon and other militarized activities, including federal prisons, immigration enforcement, and veterans benefits. An analysisby the National Priorities Project at the Institute for Policy Studies puts this figure at $887 billion, or more than 64% of the federal discretionary budgetincluding public health, education, environmental protection, job training, energy development, housing, transportation, scientific research, and more.

Making the connection: The 1033 program

Ever since images of the police deploying armored vehicles against peaceful demonstrators in Ferguson, Missouri, hit the national airwaves in 2014, the Pentagon’s program for supplying “surplus” military equipment to local police departments has been a news item. It’s also gotten intermittent attention in Congress and the Executive Branch.

Since 1997, the Pentagon’s 1033 Program, as it’s called, has channeled to 8,000 separate law enforcement agencies more than $7.4 billion in surplus equipment, including Mine-Resistant Ambush Protected (MRAP) vehicles of the kind used on the battlefields of Iraq and Afghanistan, along with rifles, ammunition, grenade launchers, and night-vision devices. As Brian Barrett has pointed out at Wired, “Local law enforcement responding to even nonviolent protests has often looked more like the U.S. Armed Forces.” Political scientist Ryan Welch co-authored a 2017 study suggesting, when it came to police departments equipped in such a fashion, “that officers with military hardware and mindsets will resort to violence more often and more quickly.”

Under the circumstances and given who’s providing the equipment, you won’t be surprised to learn that the 1033 program also suffers from lax oversight. In 2017, the Government Accountability Office (GAO) created a fake law enforcement agency and was able to acquire $1.2 million worth of equipment through the program, including night-vision goggles and simulated M-16A2 rifles. The request was approved within a week of the GAO’s application.

The Obama administration finally implemented some reforms in the wake of Ferguson, banning the transfer of tracked vehicles, grenade launchers, and weaponized aircraft, among other things, while requiring police departments to supply more detailed rationales describing their need for specific equipment. But such modest efforts — and they proved modest indeed – were promptly chucked out when Donald Trump took office. And the Trump administration changes quickly had a discernible effect. In 2019, the 1033 program had one of its biggest years ever, with about 15,750 military items transferred to law enforcement, a figure exceeded only in 2012, in the Obama years, when 17,000 such items were distributed.

As noted, the mere possession of military equipment has been shown to stoke the ever stronger “warrior culture” that now characterizes so many police departments, as evidenced by the use of Special Weapons and Tactics (SWAT) teams armed with military weaponry for routine drug enforcement activities. It’s hardly just SWAT teams, though. The weaponry and related items provided under the 1033 program are widely employed by ordinary police forces. NBC News, for instance, reported that armored vehicles were used at least 29 times in response to Black Lives Matter protests organized since the murder of George Floyd, including in major urban areas like Philadelphia and Cincinnati. NBC has also determined that more than 1,100 Mine-Resistant Ambush Protected vehicles have been distributed to local law enforcement agencies under the MRAP program, going to communities large and small, including Sanford, Maine, population 20,000, and Moundsville, West Virginia, population 8,400.

A report from the American Civil Liberties Union (ACLU) has similarly documented the use of Pentagon-supplied equipment in no-knock home invasions, including driving up to people’s houses in just such armored vehicles to launch the raids. The ACLU concluded that “the militarization of American policing is evident in the training that police officers receive, which encourages them to adopt a ‘warrior’ mentality and think of the people they are supposed to serve as enemies, as well as in the equipment they use, such as battering rams, flashbang grenades, and APCs [Armored Personnel Carriers].”

Who benefits?

Companies in the military-industrial complex earn billions of dollars selling weapons, as well as building and operating prisons and detention facilities, and supplying the police, while theoretically dealing with problems with deep social and economic roots. Generally speaking, by the time they’re done, those problems have only become deeper and more rooted. Take, for example, giant weapons contractors like Lockheed Martin, Boeing, and Raytheon that profit so splendidly from the sales of weapons systems to Saudi Arabia, weaponry that, in turn, has been used to kill tens of thousands of civilians in Yemen, destroy civilian infrastructure there, and block the provision of desperately needed humanitarian assistance. The result: more than 100,000 deaths in that country and millions more on the brink of famine and disease, including Covid-19.

Such major weapons firms have also been at the front of the line when it comes to benefiting from America’s endless post-9/11 wars. The Costs of War Project at Brown University estimates that the United States has spent over $6.4 trillion on just some of those overseas conflicts since 2001. Hundreds of billions of those dollars ended up in the pockets of defense contractors, while problems in the U.S., left far less well funded, only grew.

And by the way, the Pentagon’s regular budget, combined with direct spending on wars, also manages to provide huge benefits to such weapons makers. Almost half of the department’s $750 billion budget goes to them. According to the Federal Procurement Data System’s latest report on the top recipients of government contracts, the five largest U.S. arms makers alone — Lockheed Martin, Boeing, Raytheon, Northrop Grumman, and General Dynamics — split well over $100 billion in Pentagon awards among them in 2019. Meanwhile, those same five firms pay their CEOs a total of approximately $100 million per year, with hundreds of millions more going to other top executives and board members.

Meanwhile, in the Trump years, the militarization of the border has become a particularly lucrative business opportunity, with General Atomics, for instance, supplying ever more surveillance drones and General Dynamics supplying an ever more intricate and expensive remote sensor surveillance system. There are also millions to be made running privatized prisons and immigrant detention centers, filling the coffers of firms like CoreCivic and the GEO Group, which have secured record profits in recent years while garnering about half their revenues from those two sources.

Last but not least is the market for even more police equipment. Local forces benefit from grants from the Department of Homeland Security to purchase a wide range of items to supplement the Pentagon’s 1033 program.

The true bottom line

Much has been written about America’s failed post-9/11 wars, which have cost trillions of dollars in taxpayer treasure, hundreds of thousands of lives (American and otherwise), and physical and psychological injuries to hundreds of thousands more. They have also propped up sectarian and corrupt regimes that have actually made it easier for terrorist groups like al-Qaeda and ISIS to form and spread. Think of it as the ultimate boomerang effect, in which violence begets more violence, while allowing overseas terrorist organizations to thrive. As journalist Nick Turse has noted with respect to the militarization of U.S. Africa policy, the growth in American military operations on that continent has proceeded rather strikingly in conjunction with a proliferation of new terrorist groups. Put the best light on them and U.S. counterterror operations there have been ineffective. More likely, they have simply helped spawn further increases in terrorist activities in the region.

All of this has, in turn, been an ongoing disaster for underfunded domestic programs that would actually help ordinary Americans rather than squander their tax dollars on what passes for, but obviously isn’t, “national defense.” In the era of Covid-19, climate change, and an increased focus on longstanding structural racism and anti-black violence, a new approach to “security” is desperately needed, one that privileges not yet more bombs, guns, militarized police forces, and aircraft carriers but public health, environmental protection, and much-needed programs for quality jobs and education in underserved communities.

On the domestic front, particularly in communities of color, police are more often seen as an occupying force than a source of protection (and ever since the 1033 program was initiated, they’ve looked ever more like such a force as well). This has led to calls for defunding the police and seeking other means of providing public safety, including, minimally, not sending police to deal with petty drug offenses, domestic disputes, and problems caused by individuals with mental-health issues. Organizations like the Minneapolis-based Reclaim the Block have put forward proposals for crisis response by institutions other than the police and for community-based programs for resolving disputes and promoting restorative justice.

Shifting priorities

Sharp reductions in spending on police, prisons, and the Pentagon could free up hundreds of billions of dollars for programs that might begin to fill the gap in spending on public investments in communities of color and elsewhere.

Organizations like the Movement for Black Lives and the Poor People’s Campaign are already demanding these kinds of changes. In its moral budget, a comprehensive proposal for redirecting America’s resources toward addressing poverty and away from war, racism, and ecological destruction, the Poor People’s Campaign calls for a $350 billion annual cut in Pentagon spending — almost half of current levels. Likewise, the platform of the Movement for Black Lives suggested a 50% reduction in Pentagon outlays. And a new youth anti-militarist movement, Dissenters, has called for defunding the armed forces as well as the police.

Ultimately, safety for all Americans will depend on more than just a shift of funding or a reduction in police armaments. After all, George Floyd and Eric Garner — just two of the long list of black Americans to die at the hands of the police — were killed not with high-tech weapons, but with a knee to the throat and a fatal chokehold. Shifting funds from the police to social services, dismantling police forces as they now exist, and creating new institutions to protect communities should be an essential part of any solution in the aftermath of Donald Trump’s presidency. Similarly, investments in diplomacy, economic assistance, and cultural exchange would be needed in order to help rein in the American war machine which, of course, has been attended to in ways nothing else, from health care to schooling to infrastructure, has been in this century. When it comes to both the police and the Pentagon, the sooner change arrives the better off we’ll all be. It’s long past time to defund America’s wars, both abroad and at home.

Copyright 2020 William D. Hartung

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Sink or swim: Miami’s perilous future facing climate change

With its white-sand beaches and glittery high-rises, Miami is still a vacation hotspot. But lapping at those shores is another reality. The city is also a “possible future Atlantis, and a metonymic stand-in for how the rest of the developed world might fail — or succeed — in the climate-changed future,” writes Miami journalist Mario Alejandro Ariza in his forthcoming book, “Disposable City: Miami’s Future on the Shores of Climate Catastrophe.”

This may not be news to some. The city’s plight has been the subject of investigative reporting and even viral news stories after an octopus showed up in a parking garage following an especially high tide.

But Ariza takes a much deeper, more personal dive into the slowly unfolding disaster. Along the way he finds that the central question is whether South Florida — home to 6.5 million people — can equitably withstand what’s coming. To do so it will need to reckon with its past sins. “Miami is a damn beautiful city, and it rests on a sodden foundation of merciless racial and environmental exploitation,” he writes.

The first step is figuring out how much sea-level rise there may be and when it’s coming — but even that isn’t easy, and there’s no one definitive number. The regional climate change compact predicts two to six feet of sea-level rise by the end of the century; a NASA scientist has said eight to 10 feet.

One thing is certain, though: 20% of Miami-Dade County sits less than two feet above the sea. And by some estimates, the water could get that high in just 40 years.

The time to determine what future Miami may have is now.

After detailing that grim if uncertain reality, Ariza takes a detailed journey through South Florida’s vulnerabilities, what actions the region is taking, and those it isn’t. The first-person narrative follows Ariza through smelly, flooded city streets; a rigorous paddle to assess the risks to local infrastructure by kayak; and a day traipsing through thick swamps with two veterans to capture invasive Burmese pythons slithering amok.

This drives home a few points: South Florida’s environmental problems aren’t limited to sea-level rise — although the rising water could make much of it worse.

The draining of swamps, altering of water courses and brazen development have taken a mighty ecological toll. The Everglades are dying, and restoration efforts are painfully slow. The Miami River is choked by nutrient pollution — from leaking septic systems and fertilizer runoff — that’s killing seagrasses, a keystone species of shallow marine ecosystems, and an important buffer against storms.

Environmental collapse is just part of the problem, though. There’s also economic distress.

“If you expect to survive into the middle of the 21st century, you might just get to watch Miami die,” Ariza writes. “But not before the changing climate stretches the city’s already yawning gap between rich and poor past its breaking point.”

Miami-Dade is a majority-minority county with half its residents foreign-born. It also has an enormous wealth gap, with 6 in 10 residents spending more than one-third of their income on housing. And most of those who are struggling to make ends meet are black and Hispanic service-sector workers, Ariza explains.

It’s precisely those communities with the fewest resources that will be hardest hit by stronger storms, hotter temperatures and rising tides. These inequities “are as dangerous as the city’s low-lying topography and porous geology,” he writes.

Already a kind of climate gentrification is underway.

Ariza explains how decades of racist policies and real-estate practices have pushed communities of color away from the beach and the newly emerging suburbs. They ended up sandwiched in between, in an area of high ground that now looks enticing to developers.

This new pressure is increasing gentrification in communities already barely surviving. It’s liable to get worse, too, Ariza explains. Between $15-$23 billion worth of property may be underwater in 30 years. The market has yet to broadly reflect that, but developers are building on borrowed time, even as the lower-income communities are already feeling the pinch.

“Everything we know about climate change indicates that it pulls at society’s loose ends,” says Ariza. These cracks in vulnerability could become chasms if the right policies aren’t enacted as the city works to mitigate and adapt.

By the end of Disposable City, it’s likely readers won’t be wildly optimistic about Miami’s chances. But they will be armed with a deeper view of what’s at stake and the complexities of trying to solve an environmental and social challenge of this magnitude. Even if the city itself does everything right, it still needs the state of Florida to embrace climate reality and the rest of the world to meet science-based targets for greenhouse gas reductions. Efforts are underway, including a newly released draft plan from the Army Corps of Engineers to spend $4.6 billion on sea walls and other projects to protect businesses and homes from storm surges. But much more will be needed.

In Miami these next decades will be fight or flight. Or a combination of both. And he muses on what that would look like. And feel like. Ariza himself is an immigrant, having come to Miami from the Dominican Republic as a kid. He already carries the grief of having left a homeland — a feeling that half the city’s population also knows intimately.

“Now we have to face the fact that climate change may well force us to scatter again,” he writes.

The end of the book turns from this hard reality to a future vision as Ariza shifts to a fictional envisioning. No spoilers, but it’s safe to say Miami in 2100 will be a changed place. And that’s at least one thing we know for sure about this warming world — it is a changing one.

Ariza’s deep dive into Miami is an intricate look at his vulnerable city, but it’s likely to get readers thinking about their own. What will your hometown look like in 80 years? What do you want it to look like? What will you do to make that hope a reality?

Alzheimer’s in the era of COVID-19: What do you do when you’re estranged—and next of kin?

The message was brief and cryptic. The sender appeared to be local law enforcement in a suburban town in New Jersey, and the subject line was “police in ref to” my mother’s home address. “Please contact me ASAP about a pressing issue,” it read, along with the direct line of someone identifying himself as an officer. It was 2:41 p.m. on a recent weekday afternoon. I picked up the phone. My fingers trembled as I attempted to tap in a sequence of numbers. I spoke to a stranger for a few minutes. And this, I knew too well from experience, would be how my life would change.

I have huge gaps in my memory from the past week. I have found myself walking around outside unable to recall if I took the elevator or the stairs, or where I’m going. I don’t know if I’ve eaten at all, or had breakfast twice. Trauma can be a lot like being blackout drunk. You move around like you’re really there, doing things and having conversations, but your brain is already running parts of the story through the shredder. I do remember the skirt I was wearing that day, and looking down at the folds and ripples on my lap as I sat at the police station. I remember the oppressive heat, and the two officers walking toward me. I did however forget my wallet and my eyeglasses, leaving them behind on the chair when I finally stood up.  

When you have a parent with dementia, there’s a part of you that is always on the alert for the call. When that parent is estranged, and you’re in the midst of a pandemic, there’s no protocol for how to respond to it. The officer hadn’t given me any information on the phone. He had told me to meet him at the station as soon as possible, and that he’d talk to me then. My spouse packed our family’s tried and true emergency bag: a water bottle emblazoned with the words, “After this we’re getting pizza,” granola bar, sweater, cash and Excedrin. I called an Uber and charged it to my credit card. I put on my face mask and spent an hour staring at the Garden State Parkway, imagining the worst.

It’s a relief when you learn that your mother hasn’t killed anyone. It’s a relief when she hasn’t burned down the house. It’s a relief when a caretaker’s frustration and exhaustion haven’t led to something awful. All I know is that the cops seemed perplexed by my relatively sanguine reaction when they told me what did happen. All I can hear in my head is them repeatedly referring to me as “next of kin.”

The home health worker had discovered my stepfather’s body that morning. It appeared to be a coronary. It also appeared my mother hadn’t noticed. She definitely still doesn’t know he’s dead. They took her to the hospital, where she remains.

I haven’t seen my mother in a decade and I have only spoken to her a few times in the past 15 years. She cut herself off from my family and me long ago. I spent much of my adult life watching her grudges grow stronger and her silences longer, not just toward me but seemingly everyone. Attempts at contact were ignored, until I gave up trying.

But when the pandemic hit, I called her home to check in on her, and to my surprise, her husband answered. He told me she has advanced dementia now. He told me she was in a rehab facility. “I’m surprised you called,” he said, as though I hadn’t called so many times, for so many years. 

We spoke a few more times after that. He explained how the facility sent her home and how he couldn’t find anyplace to take her while the virus raged through the state’s elder community. He said she was putting forks in the microwave and turning on the stove gas. She told him she wished he was dead, and she would kill him if she could. He told me that he sometimes prayed God would just take him. But he was several years younger than my mom. I suppose he thought, as we all do, that there would be more time.

The policeman who told me my stepfather was dead said he talked to my mother; he’s been called out to the house plenty of times before. It’s strange to me that he knows her better now than I do. He kept trying to hand me the keys to house; I kept begging him not to make me take them. Then he reminded me they had cats, so I called the Humane Society and blubbered to them to meet me at the address.

The house was airless and messy and had the eerie emptiness of a place that had been very recently interrupted. A matted, blind cat sat in the kitchen staring into space. His companion, meanwhile, hid so well within the clutter it took the Humane Society worker a half hour to find him. I opened up the refrigerator, took out a jug of milk, and poured it into the sink. I wandered into the living room, where a photograph of my daughters and me at the beach sat atop a pile of papers. I glanced at my stepfather’s desk blotter calendar, where he’d noted in bold letters the last time my mother called the police on him.

I have no idea what happens now. If I had a normal relationship with a mother who didn’t have dementia and it wasn’t a pandemic, this would still be an enormous life event. My stepfather, who ran out of the North Tower on 9/11 and lost 84 colleagues that day, is dead. My mother is a widow. As things are, a woman who cannot speak for herself and a daughter who doesn’t know much of anything about her now have to navigate her affairs. My mother-in-law has detailed directives and a file with all her important paperwork. My own mother is a cipher. People are saying things to me like, “I’m so sorry for your loss” and “What are you going to do?” And I don’t know what to say to any of it. 

I live in a city where as of today nearly 23,000 people have died of COVID-19. I have grown uneasily accustomed these past few months to not riding the subway, not sending my kids off to school, not seeing my friends. I watched a field hospital spring up a few blocks from my apartment and saw boarded up businesses become makeshift memorials for George Floyd and Breonna Taylor. I’ve listened to the chants of protestors and the 7 p.m. cheers for healthcare workers. I’ve only gone through what we have all gone through — an unprecedented healthcare crisis and social justice movement in the midst of profound personal tumult and pain and unique, staggering challenges. 

I like my mother’s social worker. She assured me yesterday that my mom is comfortable and “pleasantly demented.” When she said that, I suddenly found myself crying. I couldn’t remember the last time anybody had told me anything positive about her.

I’m grateful that Mom doesn’t have to grieve. I’m not sure how she would manage it, even if she could. In New Jersey this week, the coronavirus transmission rate is rising. There is no memorial service currently planned.

Pandemic and prison: Shearod McFarland, incarcerated in Michigan, on what COVID-19 has changed

Shearod McFarland was born and raised in Detroit. As a teenager, he was convicted of second-degree murder and a felony firearms charge and sentenced to 25 to 40 years in Michigan state prisons. Shearod has spent more than 30 years behind bars, with more than 11 of those years in solitary confinement. 

Of the top 50 COVID-19 clusters in the United States, 33 are prisons or jails. With COVID-19 wreaking havoc in detention facilities throughout the United States, at the time of this writing in May, Michigan ranked second in the number of confirmed cases in state prisons and had the highest prison death toll of any state. Shearod communicated with us via the prison email system to describe what is currently happening at Parnall.

* * *

I’m incarcerated in Parnall Correctional Facility in Jackson, Michigan, where COVID-19 is sweeping through. My life and the lives of hundreds of other incarcerated men have changed dramatically since this pandemic began.

I started taking COVID-19 seriously when it really began spreading in New York. My fiancée lives in the Bronx, and the first cluster of cases in the state were in Westchester County, which is right outside the Bronx. I was fixated with the thought of her contracting the virus and had to fight off the sense of dread that I felt. Loss has been a constant in my life so it’s always lurking in the back of my mind. I didn’t want to experience another serious loss to this strange virus.

I heard about the first two confirmed cases of coronavirus at Parnall back in early March. Within weeks those two initial cases quickly turned into hundreds of infections. So far, Michigan prisons have over 1400 confirmed cases and more than 50 prisoner deaths. Parnall has had ten of those deaths, and counting.

It’s very difficult to get an accurate picture of just how many men here have been infected because at the beginning of the crisis the department’s response to the sick was to quarantine them in an empty cell by themselves. What kind of option is that? You get sick and basically have to be placed in solitary? Not an attractive prospect. So, unfortunately, many of the men decided that unless they became dangerously ill they would deal with the virus on their own, rather than seek medical help. The official number of infected here at Parnall is less than 200, but in reality the numbers are way higher than that. Maybe three to four times that figure.

This facility is nearly a hundred years old. It’s a petri dish-like atmosphere, viruses spread incredibly fast. Two of the housing units here are built like a massive vertical zoo, just cage on top of cage. The other three units are open-air dorms that house nearly 400 prisoners each, in what is probably less space than a small warehouse. Prisoners sleep, eat, shower, and use the bathroom in these human warehouses. So social distancing is virtually impossible.

We live in eight-man cubicles, which are approximately 20 feet by 13 feet. Each dorm has two communal showers, 10 toilets, 10 urinals, and 18 sinks for every 192 men. There is also one “quiet room” and one TV room, which are both just a little bigger than the cubicles. So the spread of a highly contagious disease like COVID-19 is inevitable if it gets into the prison.

Living under such conditions is already a high-stress situation (which probably negatively affects your immune system), but having to face the threat of a deadly pandemic ups the ante by ten. I’m not ashamed to say that the fear of death by coronavirus has crossed my mind many times. I’m in my fifties, I have asthma, and I’ve been in prison nearly 33 years straight—making me one of the more “at risk.” Some of the other men here are also quite vocal regarding their fears of the virus. But what can we do?

I personally know some of the men who have died from COVID-19. One was Garrison, who had been in prison for 44 years, since he was 16 years old. He was also just a few months from finally going home. After I heard about his death I felt horrible! I had to grieve for the man. To know that he’d spent over four decades in prison—from childhood to adulthood—only to die from this virus right when he was about to be released. It seems so tragic and unfair.

Parnall is a level-one (minimum security) facility, which generally means that the roughly 2000 men housed here get a lot of time for educational programming and recreation. But COVID-19 somehow entered the prison and changed all that. Now Parnall is like a segregated and abandoned ghost town.

Usually there’s a lot of interaction here among the prisoner population. Social interaction is a huge part of prison life. It’s how we break the monotony of incarceration. We study together, work out together, have spirited conversations, play basketball, cards, and board games like chess and checkers. But Parnall quickly became one of the epicenters of the outbreak in the Michigan Department of Corrections, and since then, all activities have ceased.

So on top of the typical soul-numbing boredom, the coronavirus has stripped us down to having even less to do. Currently, Michigan prisons have no main recreation yard or extracurricular activities like gym or weight pit. There are no visits, no educational programs running, no religious services, and no table games of any kind. All of these measures are understandable but difficult nonetheless.

Now a typical day for me has been mostly staying inside reading, talking on the telephone, and watching television. I’m an outdoorsy type, but in an attempt to control the spread of the virus within the population, the institution has separated the housing units and shut down the main recreation yard.

I’m someone who takes my mental and physical health very seriously. But now, being confined to an even smaller space than usual, I’ve found it impossible to get into a regular workout routine. I mean, I’ve been doing pushups, sit-ups, pullups, and the like, but it’s hard. And ironic too. Because now since there is no main yard, a much larger group of men are forced into a much smaller area. Which means a crowd of people all trying to work out at once indoors. Annoying. Working out is my main way of relieving stress, and being so sedentary is having an effect on me. I’m eating more and gaining weight. Ugh! I hate it.

Also, wearing these face masks has become an issue. The department gave us the masks probably a month too late and now they’re becoming a point of contention between prisoners and some officers. It’s something else to harass us about. I mean, yes, I understand the necessity, but some staff are forcing us to wear them even when we’re sitting all alone, with nobody within ten feet of us, or when we’re working out.

I don’t think that the state government has given the crisis in the prison system anywhere near what decency would require, but I can say that regardless of the value that society puts on our lives, we have been sources of support and assistance to each other. And that in itself is evidence of the rich human potential that lies behind the walls of prisons all over America.

Trump looked into selling off Puerto Rico: Ex-DHS chief

President Donald Trump’s former acting Secretary of Homeland Security says the leader of the free world considered selling Puerto Rico.

Elaine Duke, who describes herself as a lifelong Republican, spoke with The New York Times in a “wide-ranging interview” about her 14 months working for Trump.

“Among her most searing moments during the response to the hurricanes came when she heard Mr. Trump raise the possibility of ‘divesting’ or ‘selling’ Puerto Rico as the island struggled to recover,” the newspaper reported.

“Can we outsource the electricity? Can we can we sell the island? You know, or divest of that asset?” Trump reportedly asked.

Puerto Rico is an American territory, the island’s three million people are American citizens. The territory’s government estimates that 2,975 Americans were killed by the hurricane.

Duke also said she was not ready to support Trump’s re-election.

“That’s a really hard question,” she said. “But given the choices, I don’t know yet.”

Read the full report.

Federal court strikes down Trump’s rule targeting abortion access

A federal court late Friday struck down the Trump administration’s attempt to erect new barriers to abortion care, this time using the for-profit insurance industry.

US District Judge Catherine Blake in Maryland blocked the administration from implementing the so-called Patient Protection and Affordable Care Act Exchange Program Integrity rule, after Planned Parenthood of Maryland joined several individual plaintiffs in suing the Department of Health and Human Services over the regulation.

The rule was designed to force insurance companies to stop covering abortion care due to administrative burdens it would have placed on companies and patients.

Under the rule, insurance companies selling plans in the marketplaces set up by the Affordable Care Act (ACA) would have had to send two separate bills to customers—one for abortion care coverage and another for all other healthcare. Customers would have been required to pay their monthly insurance bills using two separate checks, money orders, or electronic transactions.

The rule violated the section of the ACA which bans “unreasonable barriers” to healthcare, ruled Blake, who said it would make it “harder for consumers to pay for insurance.”

According to the ACLU, which helped to represent the individual plaintiffs in the case, more than three million people who have been affected by the rule, with one-third of individual marketplace exchange plans affected. 

Like TRAP laws which impose onerous restrictions on abortion providers, including the Louisiana law which was struck down by the U.S. Supreme Court in June, the ACLU said the rule was “nothing but an intentional, targeted attack on abortion access.”

“It would have created a logistical nightmare for health insurers and individual enrollees and pushed abortion even further out of reach in the midst of a global pandemic that has upended our economy, disproportionately harming people with low-incomes, people of color, and people with disabilities,” said Meagan Burrows, a staff attorney with the organization’s Reproductive Freedom Project. “Abortion is health care—and must be treated as such.”

Planned Parenthood of Maryland and the other plaintiffs argued in the case that “although the current administration regularly touts its efforts to ‘cut federal redtape,’ HHS readily admits that the Final Rule does the opposite.”

“Defendants acknowledged that the Rule will impose $1.26 billion in costs on the public by the end of 2024 and will reduce the availability and affordability of health insurance for more than three million consumers nationwide,” the group argued. “HHS has not identified a single quantifiable benefit from the Final Rule to weigh in the balance against these costs.”

“The Final Rule will induce issuers to drop insurance coverage for abortion in order to avoid the rule’s administrative costs and will lead to a rise in premiums for those consumers with plans that maintain abortion coverage,” added Planned Parenthood in court filings. 

The administration also acknowledged, said the ACLU, that “confusion about these new requirements would have caused some people to miss payments and risk losing their health insurance coverage entirely.”

“Abortion care is healthcare, and it should not be separated, ‘carved out,’ or treated differently from any other medical service,” said Karen Nelson, president of Planned Parenthood of Maryland. “We will always fight to eliminate barriers and protect access to safe, legal abortion and we will continue to provide people with the healthcare they need.”